- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.67 / $9,780.51 / $35,012.71
| Facility | | $512.67 | $9,780.51 | $35,012.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.63 / $564.91 / $622.61
| Professional | | $485.63 | $564.91 | $622.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.14 / $660.41 / $765.08
| Professional | | $513.14 | $660.41 | $765.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,584.80 / $6,584.80 / $6,584.80
| Facility | | $6,584.80 | $6,584.80 | $6,584.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.86 / $608.33 / $1,346.08
| Professional | | $501.86 | $608.33 | $1,346.08 |