- 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
- $176.65 / $240.49 / $314.01
| Professional | | $176.65 | $240.49 | $314.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.63 / $293.26 / $437.42
| Professional | | $188.63 | $293.26 | $437.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.88 / $337.67 / $643.27
| Professional | | $222.88 | $337.67 | $643.27 |
- 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
- $228.62 / $399.05 / $594.74
| Professional | | $228.62 | $399.05 | $594.74 |