- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,248.07 / $8,709.64
| Facility | | $1,659.59 | $5,248.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $275.42 / $2,344.23
| Professional | | $74.13 | $275.42 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $758.58 / $1,949.84
| Facility | | $331.13 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |