- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.74 / $1,543.03 / $3,955.04
| Facility | | $921.74 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.33 / $198.46 / $246.81
| Professional | | $163.33 | $198.46 | $246.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.74 / $220.87 / $370.04
| Professional | | $187.74 | $220.87 | $370.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.22 / $260.23 / $450.60
| Professional | | $202.22 | $260.23 | $450.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.80 / $264.06 / $417.57
| Professional | | $170.80 | $264.06 | $417.57 |