- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $537.03 / $1,548.82
| Professional | | $478.63 | $537.03 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $933.25
| Professional | | $416.87 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $707.95 / $1,148.15
| Professional | | $120.23 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,244.36 / $13,182.57
| Facility | | $3,235.94 | $7,244.36 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,122.02
| Professional | | $478.63 | $660.69 | $1,122.02 |