- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $5,616.63
| Facility | | $455.43 | $455.43 | $5,616.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $1,651.95
| Professional | | $455.43 | $455.43 | $1,651.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,981.22 / $5,376.82 / $8,472.29
| Facility | | $2,981.22 | $5,376.82 | $8,472.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.87 / $986.55 / $1,095.07
| Professional | | $896.87 | $986.55 | $1,095.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,753.25 / $2,753.25 / $2,753.25
| Facility | | $2,753.25 | $2,753.25 | $2,753.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,881.02 / $5,282.15 / $19,446.12
| Facility | | $2,881.02 | $5,282.15 | $19,446.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,376.63 / $3,579.23
| Professional | | $1,156.36 | $1,376.63 | $3,579.23 |