- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $6,606.93
| Facility | | $1,288.25 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $1,737.80
| Professional | | $933.25 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $1,862.09
| Professional | | $1,047.13 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,412.54 / $4,466.84
| Facility | | $354.81 | $1,412.54 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $7,585.78
| Professional | | $912.01 | $1,230.27 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,318.26 / $2,630.27
| Facility | | $354.81 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,174.90 / $1,819.70
| Professional | | $912.01 | $1,174.90 | $1,819.70 |