- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $741.31 / $4,365.16
| Facility | | $380.19 | $741.31 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $478.63 / $831.76
| Professional | | $363.08 | $478.63 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $1,778.28
| Facility | | $363.08 | $501.19 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $1,122.02
| Professional | | $407.38 | $549.54 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $3,162.28
| Facility | | $549.54 | $549.54 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $1,202.26
| Professional | | $398.11 | $398.11 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $478.63 / $1,096.48
| Facility | | $309.03 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $707.95
| Professional | | $316.23 | $436.52 | $707.95 |