- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,162.28 / $4,570.88
| Facility | | $407.38 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $95.50 / $407.38
| Professional | | $74.13 | $95.50 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $120.23
| Professional | | $109.65 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $107.15
| Professional | | $30.20 | $44.67 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $112.20 / $134.90
| Professional | | $97.72 | $112.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $95.50 / $123.03
| Professional | | $57.54 | $95.50 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $120.23 / $141.25
| Professional | | $114.82 | $120.23 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $95.50 / $151.36
| Professional | | $79.43 | $95.50 | $151.36 |