- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $288.40
| Professional | | $141.25 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $186.21 / $204.17
| Professional | | $147.91 | $186.21 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $245.47
| Professional | | $158.49 | $204.17 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $524.81 / $2,754.23
| Facility | | $144.54 | $524.81 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $186.21 / $1,148.15
| Professional | | $138.04 | $186.21 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $630.96 / $1,659.59
| Facility | | $138.04 | $630.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $165.96 / $245.47
| Professional | | $131.83 | $165.96 | $245.47 |