- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,513.56 / $2,570.40
| Facility | | $630.96 | $1,513.56 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $1,230.27
| Professional | | $524.81 | $602.56 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $3,467.37
| Professional | | $1,148.15 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,630.78 / $4,570.88
| Facility | | $3,235.94 | $3,630.78 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,202.26
| Professional | | $602.56 | $912.01 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,162.28 / $9,332.54
| Facility | | $954.99 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,380.38
| Professional | | $512.86 | $660.69 | $1,380.38 |