- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.11 / $1,218.32 / $2,930.84
| Facility | | $859.11 | $1,218.32 | $2,930.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.85 / $975.70 / $1,490.75
| Professional | | $589.85 | $975.70 | $1,490.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.39 / $1,113.83 / $2,307.75
| Facility | | $698.39 | $1,113.83 | $2,307.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.89 / $813.35 / $1,379.35
| Professional | | $509.89 | $813.35 | $1,379.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.43 / $612.65 / $1,005.14
| Facility | | $340.43 | $612.65 | $1,005.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.70 / $1,241.70 / $2,352.54
| Professional | | $1,241.70 | $1,241.70 | $2,352.54 |