- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,412.54
| Facility | | $1,202.26 | $1,202.26 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $602.56 / $1,122.02
| Professional | | $309.03 | $602.56 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81,283.05 / $81,283.05 / $81,283.05
| Facility | | $81,283.05 | $81,283.05 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72,443.60 / $72,443.60 / $72,443.60
| Professional | | $72,443.60 | $72,443.60 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Facility | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $562.34
| Facility | | $457.09 | $457.09 | $562.34 |