- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.28 / $4,604.83 / $8,042.03
| Facility | | $3,204.28 | $4,604.83 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.51 / $569.42 / $1,007.12
| Professional | | $362.51 | $569.42 | $1,007.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.69 / $1,100.22 / $9,388.90
| Facility | | $687.69 | $1,100.22 | $9,388.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.00 / $1,193.08 / $3,170.91
| Facility | | $645.00 | $1,193.08 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |