- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,691.53 / $5,128.61
| Facility | | $2,630.27 | $2,691.53 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,513.56 / $2,818.38
| Professional | | $363.08 | $1,513.56 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $676.08 / $1,737.80
| Facility | | $380.19 | $676.08 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,445.44 / $4,168.69
| Facility | | $478.63 | $1,445.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,862.09 / $3,715.35
| Facility | | $645.65 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Professional | | $154.88 | $154.88 | $154.88 |