- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $5,370.32 / $7,413.10
| Facility | | $707.95 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $977.24
| Professional | | $346.74 | $512.86 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,290.87 / $3,548.13
| Facility | | $870.96 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,071.52
| Professional | | $457.09 | $691.83 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $1,096.48
| Professional | | $363.08 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $676.08 / $870.96
| Professional | | $426.58 | $676.08 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,513.56 / $2,511.89
| Facility | | $354.81 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $602.56 / $1,230.27
| Professional | | $354.81 | $602.56 | $1,230.27 |