- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,943.28 / $15,135.61
| Facility | | $7,079.46 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,778.28 / $12,589.25
| Professional | | $1,584.89 | $1,778.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,762.47 / $15,135.61
| Facility | | $5,888.44 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,230.27 / $4,365.16
| Facility | | $288.40 | $1,230.27 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,230.27 / $4,466.84
| Facility | | $295.12 | $1,230.27 | $4,466.84 |