- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,288.25 / $2,041.74
| Facility | | $524.81 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $380.19 / $602.56
| Professional | | $331.13 | $380.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,570.88
| Facility | | $3,311.31 | $3,311.31 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $501.19
| Professional | | $380.19 | $380.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $2,290.87
| Facility | | $489.78 | $512.86 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $537.03 / $676.08
| Professional | | $354.81 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $5,370.32
| Facility | | $812.83 | $1,819.70 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $691.83
| Professional | | $331.13 | $436.52 | $691.83 |