- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,511.89 / $6,760.83
| Facility | | $676.08 | $2,511.89 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $707.95 / $1,621.81
| Professional | | $380.19 | $707.95 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $933.25 / $3,630.78
| Facility | | $478.63 | $933.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $1,380.38
| Professional | | $891.25 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,073.80 / $6,309.57
| Facility | | $2,041.74 | $4,073.80 | $6,309.57 |