- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.25 / $3,666.78 / $7,119.04
| Facility | | $1,175.25 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.83 / $820.89 / $1,517.59
| Professional | | $505.83 | $820.89 | $1,517.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.04 / $1,486.83 / $8,328.70
| Facility | | $766.04 | $1,486.83 | $8,328.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.00 / $1,702.95 / $2,769.67
| Facility | | $939.00 | $1,702.95 | $2,769.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |