- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,344.23 / $4,168.69
| Facility | | $1,318.26 | $2,344.23 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $2,344.23 / $3,162.28
| Professional | | $263.03 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $2,398.83 / $6,606.93
| Facility | | $0.03 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $2,398.83 / $6,606.93
| Facility | | $0.03 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,630.78 / $8,511.38
| Facility | | $1,258.93 | $3,630.78 | $8,511.38 |