- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $9,120.11 / $16,595.87
| Facility | | $190.55 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $190.55 / $251.19
| Professional | | $158.49 | $190.55 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,905.46 / $3,890.45
| Facility | | $891.25 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $186.21 / $407.38
| Professional | | $169.82 | $186.21 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $436.52
| Facility | | $181.97 | $234.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $54.95
| Professional | | $30.20 | $30.20 | $54.95 |