- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,238.72 / $7,762.47
| Facility | | $812.83 | $2,238.72 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,548.82
| Professional | | $1,071.52 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $831.76 / $1,258.93
| Facility | | $630.96 | $831.76 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $6,606.93
| Facility | | $1,230.27 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $28,840.32
| Facility | | $8,912.51 | $8,912.51 | $28,840.32 |