- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.02 / $1,767.57 / $3,074.04
| Facility | | $1,537.02 | $1,767.57 | $3,074.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.88 / $1,306.47 / $1,490.91
| Professional | | $1,198.88 | $1,306.47 | $1,490.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.71 / $217.32 / $997.30
| Professional | | $169.71 | $217.32 | $997.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.06 / $1,248.83 / $3,326.87
| Facility | | $999.06 | $1,248.83 | $3,326.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.54 / $645.54 / $1,537.02
| Professional | | $645.54 | $645.54 | $1,537.02 |