- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,884.03 / $8,511.38
| Facility | | $338.84 | $2,884.03 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $1,380.38
| Professional | | $295.12 | $446.68 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $933.25
| Professional | | $630.96 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,122.02
| Professional | | $446.68 | $691.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $549.54 / $1,096.48
| Facility | | $338.84 | $549.54 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $616.60 / $2,630.27
| Professional | | $354.81 | $616.60 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,677.35 / $5,128.61
| Facility | | $3,090.30 | $4,677.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $616.60 / $831.76
| Professional | | $354.81 | $616.60 | $831.76 |