- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,445.44 / $2,398.83
| Facility | | $616.60 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $741.31
| Professional | | $275.42 | $416.87 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,041.74
| Facility | | $1,258.93 | $1,513.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $616.60
| Professional | | $309.03 | $446.68 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $891.25
| Professional | | $281.84 | $446.68 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $602.56 / $1,548.82
| Facility | | $251.19 | $602.56 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $602.56
| Professional | | $234.42 | $363.08 | $602.56 |