- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,630.78 / $8,317.64
| Facility | | $812.83 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $1,023.29
| Professional | | $691.83 | $870.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,737.80
| Professional | | $812.83 | $1,023.29 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,412.54
| Facility | | $691.83 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $6,918.31
| Facility | | $630.96 | $870.96 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,079.46 / $13,803.84
| Facility | | $3,630.78 | $7,079.46 | $13,803.84 |