- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $8,511.38
| Facility | | $173.78 | $251.19 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $295.12
| Professional | | $173.78 | $251.19 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $524.81
| Facility | | $173.78 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $426.58 / $691.83
| Professional | | $275.42 | $426.58 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,041.74 / $2,511.89
| Facility | | $1,148.15 | $2,041.74 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $537.03
| Professional | | $269.15 | $398.11 | $537.03 |