- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.70 / $1,904.22 / $3,706.14
| Facility | | $920.70 | $1,904.22 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.31 / $74.62 / $106.93
| Professional | | $40.31 | $74.62 | $106.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.47 / $102.49 / $184.35
| Professional | | $53.47 | $102.49 | $184.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.05 / $125.08 / $257.79
| Professional | | $63.05 | $125.08 | $257.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.17 / $128.84 / $226.38
| Professional | | $75.17 | $128.84 | $226.38 |