- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $12,022.64
| Facility | | $2,137.96 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $331.13
| Professional | | $245.47 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $2,137.96
| Facility | | $630.96 | $870.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $524.81 / $1,023.29
| Professional | | $269.15 | $524.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $4,786.30
| Facility | | $1,071.52 | $1,698.24 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $234.42 / $436.52
| Professional | | $125.89 | $234.42 | $436.52 |