- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $2,511.89 / $6,760.83
| Facility | | $380.19 | $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
- $213.80 / $831.76 / $1,380.38
| Professional | | $213.80 | $831.76 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $794.33 / $2,951.21
| Facility | | $323.59 | $794.33 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,202.26 / $1,737.80
| Professional | | $537.03 | $1,202.26 | $1,737.80 |
- 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
- $1,778.28 / $3,630.78 / $6,309.57
| Facility | | $1,778.28 | $3,630.78 | $6,309.57 |