- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $3,467.37
| Facility | | $1,348.96 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,398.83 / $2,398.83
| Professional | | $2,290.87 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,621.81 / $2,187.76
| Facility | | $512.86 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,288.25 / $1,778.28
| Professional | | $691.83 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $1,819.70
| Professional | | $30.20 | $30.20 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,122.02 / $1,202.26
| Facility | | $1,047.13 | $1,122.02 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $794.33 / $1,230.27
| Professional | | $741.31 | $794.33 | $1,230.27 |