- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.77 / $1,083.00 / $2,812.00
| Facility | | $296.77 | $1,083.00 | $2,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.11 / $235.88 / $296.77
| Professional | | $79.11 | $235.88 | $296.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.56 / $106.71 / $307.60
| Professional | | $72.56 | $106.71 | $307.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.87 / $318.54 / $480.00
| Professional | | $127.87 | $318.54 | $480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $337.00 / $858.00
| Facility | | $130.00 | $337.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.19 / $310.56 / $511.08
| Professional | | $255.19 | $310.56 | $511.08 |