- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.54 / $7,030.11 / $13,071.19
| Facility | | $859.54 | $7,030.11 | $13,071.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.46 / $627.36 / $738.07
| Professional | | $590.46 | $627.36 | $738.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.31 / $895.34 / $1,843.64
| Facility | | $342.31 | $895.34 | $1,843.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.05 / $615.05 / $627.35
| Professional | | $615.05 | $615.05 | $627.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.36 / $627.36 / $1,411.70
| Facility | | $627.36 | $627.36 | $1,411.70 |
- 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
- $533.26 / $627.36 / $627.36
| Professional | | $533.26 | $627.36 | $627.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,105.58 / $4,105.58 / $4,105.58
| Facility | | $4,105.58 | $4,105.58 | $4,105.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.30 / $615.05 / $651.96
| Professional | | $584.30 | $615.05 | $651.96 |