- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.53 / $105.13 / $135.06
| Professional | | $84.53 | $105.13 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.70 / $146.85 / $204.04
| Professional | | $96.70 | $146.85 | $204.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.61 / $156.21 / $286.89
| Professional | | $111.61 | $156.21 | $286.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.48 / $178.93 / $256.99
| Professional | | $104.48 | $178.93 | $256.99 |