- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $3,162.28 / $7,762.47
| Facility | | $186.21 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $263.03
| Professional | | $107.15 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $323.59
| Professional | | $245.47 | $275.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $181.97 / $380.19
| Professional | | $169.82 | $181.97 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $549.54 / $5,888.44
| Facility | | $165.96 | $549.54 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $588.84
| Professional | | $263.03 | $380.19 | $588.84 |