- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $4,365.16
| Facility | | $1,258.93 | $1,258.93 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $3,388.44
| Facility | | $1,621.81 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,884.03 / $3,090.30
| Professional | | $2,754.23 | $2,884.03 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $2,570.40
| Professional | | $1,737.80 | $2,238.72 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Professional | 80 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |