- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,548.13 / $4,365.16
| Facility | | $1,096.48 | $3,548.13 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,288.25 / $2,884.03
| Facility | | $776.25 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,398.83 / $2,398.83
| Professional | | $2,238.72 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $2,041.74
| Professional | | $1,174.90 | $1,737.80 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | 80 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |