- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.65 / $1,714.01 / $4,123.29
| Facility | | $1,208.65 | $1,714.01 | $4,123.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.33 / $812.78 / $2,064.59
| Professional | | $176.33 | $812.78 | $2,064.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.54 / $1,567.02 / $3,246.69
| Facility | | $982.54 | $1,567.02 | $3,246.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.68 / $668.14 / $1,793.75
| Professional | | $147.68 | $668.14 | $1,793.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.35 / $742.72 / $1,342.35
| Facility | | $108.35 | $742.72 | $1,342.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,284.00 / $4,284.00 / $4,284.00
| Professional | | $4,284.00 | $4,284.00 | $4,284.00 |