- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $3,981.07
| Facility | | $436.52 | $436.52 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $104.71 / $263.03
| Professional | | $57.54 | $104.71 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $85.11 / $134.90
| Professional | | $52.48 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $112.20 / $190.55
| Professional | | $60.26 | $112.20 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,412.54 / $6,456.54
| Facility | | $426.58 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $93.33 / $151.36
| Professional | | $66.07 | $93.33 | $151.36 |