- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $2,951.21
| Facility | | $1,096.48 | $1,737.80 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,995.26 / $8,317.64
| Professional | | $147.91 | $1,995.26 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,073.80 / $5,623.41
| Facility | | $3,467.37 | $4,073.80 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,365.16 / $7,079.46
| Facility | | $1,479.11 | $4,365.16 | $7,079.46 |