- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $562.34 / $3,090.30
| Facility | | $229.09 | $562.34 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,187.76
| Facility | | $1,174.90 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $758.58 / $3,715.35
| Facility | | $269.15 | $758.58 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $741.31 / $3,630.78
| Facility | | $269.15 | $741.31 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $1,548.82
| Professional | | $489.78 | $851.14 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,137.96 / $2,137.96
| Facility | | $1,445.44 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $4,677.35
| Facility | | $2,238.72 | $2,818.38 | $4,677.35 |