- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,309.57
| Facility | | $1,230.27 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $912.01 / $3,467.37
| Professional | | $186.21 | $912.01 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,318.26 / $1,995.26
| Facility | | $416.87 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $389.05 / $1,096.48
| Professional | | $346.74 | $389.05 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,412.54 / $2,238.72
| Facility | | $707.95 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,122.02 / $2,187.76
| Facility | | $199.53 | $1,122.02 | $2,187.76 |