- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,265.80 / $8,317.64
| Facility | | $870.96 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,122.02 / $2,344.23
| Facility | | $501.19 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Professional | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,258.93
| Facility | | $616.60 | $776.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,890.45 / $9,549.93
| Facility | | $912.01 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $45,708.82
| Facility | | $7,943.28 | $7,943.28 | $45,708.82 |