- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,943.28 / $14,454.40
| Facility | | $5,495.41 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,801.89 / $7,762.47
| Facility | | $3,019.95 | $3,801.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $7,943.28
| Facility | | $275.42 | $407.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $549.54 / $758.58
| Professional | | $524.81 | $549.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |