- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,513.56 / $3,981.07
| Facility | | $1,202.26 | $1,513.56 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $190.55 / $371.54
| Professional | | $85.11 | $190.55 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $112.20 / $173.78
| Professional | | $70.79 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $162.18 / $309.03
| Professional | | $97.72 | $162.18 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $147.91 / $269.15
| Professional | | $87.10 | $147.91 | $269.15 |