- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,513.56 / $2,454.71
| Facility | | $549.54 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $562.34
| Professional | | $380.19 | $501.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $4,897.79
| Facility | | $3,630.78 | $3,630.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $575.44
| Professional | | $436.52 | $436.52 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $794.33
| Professional | | $363.08 | $645.65 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,951.21 / $11,220.18
| Facility | | $1,230.27 | $2,951.21 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $446.68 / $812.83
| Professional | | $371.54 | $446.68 | $812.83 |