- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,398.83
| Facility | | $1,258.93 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $489.78
| Professional | | $245.47 | $371.54 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $40,738.03 / $54,954.09
| Facility | | $33,884.42 | $40,738.03 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $14,454.40 / $29,512.09
| Facility | | $3,467.37 | $14,454.40 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $645.65
| Professional | | $302.00 | $436.52 | $645.65 |