- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.02 / $420.02 / $56,804.42
| Facility | | $305.02 | $420.02 | $56,804.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.14 / $311.13 / $311.13
| Professional | | $300.14 | $311.13 | $311.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,014.04 / $64,335.02 / $86,551.19
| Facility | | $53,014.04 | $64,335.02 | $86,551.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.13 / $311.13 / $311.13
| Facility | | $311.13 | $311.13 | $311.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.13 / $311.13 / $311.13
| Professional | | $311.13 | $311.13 | $311.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.68 / $305.02 / $305.02
| Professional | | $290.68 | $305.02 | $305.02 |