- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.13 / $108.90 / $6,873.74
| Facility | | $61.13 | $108.90 | $6,873.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.26 / $131.18 / $32,026.29
| Professional | | $70.26 | $131.18 | $32,026.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.55 / $102.18 / $11,095.54
| Facility | | $84.55 | $102.18 | $11,095.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.92 / $92.92 / $6,812.28
| Professional | | $92.92 | $92.92 | $6,812.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.97 / $130.09 / $153.05
| Professional | | $70.97 | $130.09 | $153.05 |