- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.72 / $146.55 / $237.84
| Professional | | $134.72 | $146.55 | $237.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.49 / $5,011.47 / $6,926.75
| Facility | | $1,383.49 | $5,011.47 | $6,926.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.29 / $193.25 / $331.17
| Professional | | $167.29 | $193.25 | $331.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.08 / $1,981.08 / $3,482.61
| Facility | | $484.08 | $1,981.08 | $3,482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.25 / $283.12 / $435.51
| Professional | | $155.25 | $283.12 | $435.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.01 / $261.70 / $568.76
| Professional | | $166.01 | $261.70 | $568.76 |