- 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
- $115.89 / $192.84 / $305.48
| Professional | | $115.89 | $192.84 | $305.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.50 / $290.51 / $402.47
| Professional | | $158.50 | $290.51 | $402.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.17 / $277.02 / $572.50
| Professional | | $168.17 | $277.02 | $572.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.78 / $396.84 / $614.95
| Professional | | $243.78 | $396.84 | $614.95 |