- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.22 / $1,518.41 / $3,955.04
| Facility | | $307.22 | $1,518.41 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.05 / $144.63 / $238.75
| Professional | | $91.05 | $144.63 | $238.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.18 / $177.48 / $228.23
| Professional | | $123.18 | $177.48 | $228.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.45 / $190.95 / $299.38
| Professional | | $114.45 | $190.95 | $299.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,183.00 / $3,774.00
| Facility | | $437.00 | $1,183.00 | $3,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.41 / $186.72 / $316.02
| Professional | | $142.41 | $186.72 | $316.02 |