- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $162.18 / $263.03
| Professional | | $102.33 | $162.18 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $389.05
| Facility | | $162.18 | $323.59 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $138.04 / $190.55
| Professional | | $114.82 | $138.04 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $257.04 / $446.68
| Professional | | $144.54 | $257.04 | $446.68 |