- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Professional | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $3,467.37 / $4,570.88
| Professional | | $213.80 | $3,467.37 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $58,884.37 / $64,565.42
| Facility | | $45,708.82 | $58,884.37 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $35,481.34 / $41,686.94
| Facility | | $30,199.52 | $35,481.34 | $41,686.94 |