- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.06 / $815.18 / $8,462.33
| Facility | | $224.06 | $815.18 | $8,462.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.32 / $205.88 / $224.06
| Professional | | $194.32 | $205.88 | $224.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.57 / $226.80 / $436.03
| Professional | | $178.57 | $226.80 | $436.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.17 / $1,297.49 / $1,495.36
| Facility | | $725.17 | $1,297.49 | $1,495.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.23 / $175.17 / $582.63
| Professional | | $111.23 | $175.17 | $582.63 |