- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,513.56 / $3,548.13
| Facility | | $549.54 | $1,513.56 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $1,047.13
| Professional | | $436.52 | $512.86 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,412.54 / $5,248.07
| Facility | | $676.08 | $1,412.54 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $2,398.83
| Professional | | $245.47 | $354.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,288.25 / $3,090.30
| Facility | | $562.34 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,318.26 / $2,511.89
| Professional | | $331.13 | $1,318.26 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $776.25 / $1,380.38
| Facility | | $398.11 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $1,047.13
| Professional | | $245.47 | $354.81 | $1,047.13 |