- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.06 / $1,746.92 / $3,038.12
| Facility | | $1,519.06 | $1,746.92 | $3,038.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.86 / $1,746.92 / $1,746.92
| Professional | | $1,184.86 | $1,746.92 | $1,746.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.39 / $486.30 / $985.64
| Professional | | $400.39 | $486.30 | $985.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.74 / $1,283.60 / $4,763.80
| Facility | | $1,194.74 | $1,283.60 | $4,763.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.15 / $1,367.15 / $1,367.15
| Facility | | $1,367.15 | $1,367.15 | $1,367.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $638.01 / $911.44
| Professional | | $638.01 | $638.01 | $911.44 |