- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,801.89 / $8,128.31
| Facility | | $1,348.96 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $2,511.89 / $3,630.78
| Professional | | $630.96 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $446.68 / $1,698.24
| Facility | | $54.95 | $446.68 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $416.87 / $1,778.28
| Facility | | $177.83 | $416.87 | $1,778.28 |