- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,445.44 / $2,398.83
| Facility | | $524.81 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $616.60
| Professional | | $245.47 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,235.94 / $4,365.16
| Facility | | $2,754.23 | $3,235.94 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $602.56
| Professional | | $354.81 | $446.68 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $660.69
| Professional | | $239.88 | $323.59 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,951.21 / $4,365.16
| Facility | | $812.83 | $2,951.21 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $457.09
| Professional | | $199.53 | $281.84 | $457.09 |