- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,762.47 / $14,791.08
| Facility | | $2,041.74 | $7,762.47 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $186.21 / $371.54
| Professional | | $48.98 | $186.21 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $85.11
| Professional | | $60.26 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $537.03
| Facility | | $47.86 | $47.86 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $21,379.62 / $36,307.81
| Facility | | $1,659.59 | $21,379.62 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $79.43 / $104.71
| Professional | | $58.88 | $79.43 | $104.71 |