- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.53 / $1,065.63 / $1,638.87
| Facility | | $584.53 | $1,065.63 | $1,638.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.75 / $640.54 / $1,745.57
| Professional | | $551.75 | $640.54 | $1,745.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.62 / $1,830.07 / $2,974.33
| Facility | | $454.62 | $1,830.07 | $2,974.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.30 / $512.44 / $3,475.07
| Professional | | $352.30 | $512.44 | $3,475.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.29 / $546.29 / $546.29
| Facility | | $546.29 | $546.29 | $546.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.29 / $546.29 / $546.29
| Professional | | $546.29 | $546.29 | $546.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.38 / $832.70 / $1,165.50
| Facility | | $529.38 | $832.70 | $1,165.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.38 / $529.38 / $529.38
| Professional | | $529.38 | $529.38 | $529.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.29 / $546.29 / $546.29
| Professional | | $546.29 | $546.29 | $546.29 |