- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $3,981.07
| Facility | | $398.11 | $398.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $158.49 / $398.11
| Professional | | $43.65 | $158.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $74.13 / $154.88
| Professional | | $36.31 | $74.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $123.03 / $263.03
| Professional | | $51.29 | $123.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $97.72 / $234.42
| Professional | | $46.77 | $97.72 | $234.42 |