- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $3,981.07
| Facility | | $3,019.95 | $3,715.35 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $131.83 / $331.13
| Professional | | $83.18 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $120.23 / $213.80
| Professional | | $91.20 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $194.98 / $251.19
| Professional | | $91.20 | $194.98 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $151.36 / $257.04
| Professional | | $97.72 | $151.36 | $257.04 |