- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,065.50 / $2,816.37 / $6,907.00
| Facility | | $2,065.50 | $2,816.37 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.64 / $120.25 / $181.41
| Professional | | $36.64 | $120.25 | $181.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.84 / $134.90 / $246.99
| Professional | | $42.84 | $134.90 | $246.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,148.51 / $2,148.51 / $2,865.33
| Facility | | $2,148.51 | $2,148.51 | $2,865.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $36.26 / $36.26
| Professional | | $36.26 | $36.26 | $36.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.74 / $180.27 / $356.18
| Professional | | $131.74 | $180.27 | $356.18 |