- 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
- $83.39 / $112.73 / $154.31
| Professional | | $83.39 | $112.73 | $154.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.89 / $158.81 / $221.91
| Professional | | $97.89 | $158.81 | $221.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.68 / $194.23 / $315.58
| Professional | | $133.68 | $194.23 | $315.58 |
- 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
- $117.57 / $192.50 / $337.99
| Professional | | $117.57 | $192.50 | $337.99 |