- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,412.54 / $1,698.24
| Facility | | $346.74 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,096.48 / $1,862.09
| Professional | | $346.74 | $1,096.48 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $436.52
| Facility | | $354.81 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,862.09
| Facility | | $562.34 | $562.34 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $10,232.93
| Professional | | $323.59 | $1,348.96 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $8,912.51
| Facility | | $2,884.03 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $870.96 / $2,344.23
| Professional | | $288.40 | $870.96 | $2,344.23 |