- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $2,884.03
| Facility | | $426.58 | $562.34 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $93.33 / $229.09
| Professional | | $37.15 | $93.33 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $74.13 / $165.96
| Professional | | $37.15 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $93.33 / $234.42
| Professional | | $50.12 | $93.33 | $234.42 |
- 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
- $45.71 / $95.50 / $186.21
| Professional | | $45.71 | $95.50 | $186.21 |