- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $7,244.36
| Facility | | $3,235.94 | $6,025.60 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $489.78 / $1,096.48
| Professional | | $380.19 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $776.25
| Professional | | $354.81 | $446.68 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $6,918.31
| Facility | | $5,370.32 | $5,370.32 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $2,187.76
| Facility | | $1,258.93 | $1,258.93 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $630.96
| Professional | | $331.13 | $416.87 | $630.96 |