- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $12,589.25
| Facility | | $2,137.96 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $199.53 / $478.63
| Facility | | $144.54 | $199.53 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $234.42
| Professional | | $104.71 | $144.54 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $741.31 / $2,454.71
| Facility | | $338.84 | $741.31 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $95.50 / $309.03
| Professional | | $50.12 | $95.50 | $309.03 |