- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,235.94 / $7,244.36
| Facility | | $1,096.48 | $3,235.94 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $1,096.48
| Professional | | $741.31 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,479.11 / $1,905.46
| Professional | | $1,202.26 | $1,479.11 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $1,698.24
| Facility | | $776.25 | $1,096.48 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,096.48 / $7,413.10
| Facility | | $794.33 | $1,096.48 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |