- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,244.36 / $13,489.63
| Facility | | $3,019.95 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,698.24 / $3,311.31
| Facility | | $1,318.26 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $724.44 / $8,912.51
| Facility | | $389.05 | $724.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $776.25 / $1,071.52
| Professional | | $758.58 | $776.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,623.41 / $8,912.51
| Facility | | $4,677.35 | $5,623.41 | $8,912.51 |