- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.78 / $2,163.17 / $3,606.86
| Facility | | $466.78 | $2,163.17 | $3,606.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.06 / $442.83 / $657.54
| Professional | | $295.06 | $442.83 | $657.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.44 / $360.50 / $392.78
| Facility | | $324.44 | $360.50 | $392.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.64 / $349.14 / $349.14
| Professional | | $267.64 | $349.14 | $349.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.24 / $520.24 / $520.24
| Facility | | $520.24 | $520.24 | $520.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.70 / $542.37 / $1,216.15
| Professional | | $312.70 | $542.37 | $1,216.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,250.18 / $8,250.18 / $8,250.18
| Facility | | $8,250.18 | $8,250.18 | $8,250.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.18 / $550.37 / $796.64
| Professional | | $360.18 | $550.37 | $796.64 |