- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,389.44 / $4,241.22 / $13,841.56
| Facility | | $2,389.44 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.25 / $407.22 / $525.19
| Professional | | $181.25 | $407.22 | $525.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,118.27 / $6,731.93 / $13,021.72
| Facility | | $5,118.27 | $6,731.93 | $13,021.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.64 / $1,775.00 / $6,169.00
| Facility | | $769.64 | $1,775.00 | $6,169.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.04 / $2,679.00 / $6,169.00
| Facility | | $482.04 | $2,679.00 | $6,169.00 |