- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,047.13 / $1,995.26
| Facility | | $416.87 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $44.67 / $77.62
| Professional | | $36.31 | $44.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $64.57 / $102.33
| Professional | | $39.81 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $562.34 / $1,621.81
| Facility | | $213.80 | $562.34 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $48.98 / $104.71
| Professional | | $34.67 | $48.98 | $104.71 |