- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.36 / $5,659.23 / $13,011.48
| Facility | | $627.36 | $5,659.23 | $13,011.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.46 / $612.60 / $771.87
| Professional | | $590.46 | $612.60 | $771.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.44 / $665.57 / $1,220.05
| Facility | | $332.44 | $665.57 | $1,220.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.37 / $615.05 / $664.26
| Professional | | $585.37 | $615.05 | $664.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.36 / $738.14 / $1,107.22
| Facility | | $627.36 | $738.14 | $1,107.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.36 / $627.36 / $627.36
| Professional | | $627.36 | $627.36 | $627.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.05 / $615.05 / $723.31
| Professional | | $615.05 | $615.05 | $723.31 |