- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $6,918.31
| Facility | | $1,071.52 | $1,995.26 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $234.42 / $575.44
| Professional | | $28.84 | $234.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $11,748.98
| Facility | | $8,709.64 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,762.47 / $15,135.61
| Facility | | $3,715.35 | $7,762.47 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $63.10 / $389.05
| Professional | | $43.65 | $63.10 | $389.05 |