- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.11 / $227.51 / $654.13
| Professional | | $206.11 | $227.51 | $654.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.92 / $1,100.14 / $1,283.44
| Facility | | $786.92 | $1,100.14 | $1,283.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.73 / $602.98 / $643.90
| Professional | | $450.73 | $602.98 | $643.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.82 / $540.82 / $540.82
| Professional | | $540.82 | $540.82 | $540.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,517.00 / $4,602.00
| Facility | | $1,388.00 | $2,517.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.74 / $608.21 / $853.34
| Professional | | $439.74 | $608.21 | $853.34 |