- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $3,162.28 / $6,025.60
| Facility | | $169.82 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $512.86 / $1,862.09
| Professional | | $123.03 | $512.86 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $60.26
| Professional | | $30.20 | $44.67 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $346.74 / $758.58
| Facility | | $295.12 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |