- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,862.09 / $5,011.87
| Facility | | $912.01 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $16,982.44 / $17,782.79
| Facility | | $891.25 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.09 / $229.09 / $1,096.48
| Professional | | $3.09 | $229.09 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,995.26 / $6,309.57
| Facility | | $724.44 | $1,995.26 | $6,309.57 |