- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $2,187.76 / $8,511.38
| Facility | | $275.42 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,884.03 / $5,623.41
| Facility | | $2,238.72 | $2,884.03 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $281.84 / $1,778.28
| Facility | | $134.90 | $281.84 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $331.13 / $436.52
| Professional | | $269.15 | $331.13 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,230.27 / $4,466.84
| Facility | | $295.12 | $1,230.27 | $4,466.84 |