- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $8,709.64 / $16,595.87
| Facility | | $537.03 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,248.07 / $10,232.93
| Facility | | $1,318.26 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $588.84 / $3,801.89
| Facility | | $562.34 | $588.84 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $630.96
| Professional | | $562.34 | $562.34 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $870.96
| Facility | | $371.54 | $524.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $17,378.01
| Facility | | $933.25 | $10,232.93 | $17,378.01 |