- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $15,135.61
| Facility | | $4,073.80 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $1,412.54
| Facility | | $426.58 | $575.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $194.98 / $223.87
| Professional | | $177.83 | $194.98 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,137.96 / $6,456.54
| Facility | | $724.44 | $2,137.96 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $630.96
| Professional | | $275.42 | $407.38 | $630.96 |