- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.84 / $1,216.95 / $3,706.14
| Facility | | $670.84 | $1,216.95 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.88 / $98.02 / $163.38
| Professional | | $57.88 | $98.02 | $163.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.84 / $128.16 / $161.25
| Professional | | $80.84 | $128.16 | $161.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.79 / $137.87 / $208.98
| Professional | | $74.79 | $137.87 | $208.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.02 / $144.86 / $223.64
| Professional | | $105.02 | $144.86 | $223.64 |