- 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
- $132.36 / $221.58 / $312.44
| Professional | | $132.36 | $221.58 | $312.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.11 / $319.22 / $464.90
| Professional | | $177.11 | $319.22 | $464.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.00 / $301.12 / $620.88
| Professional | | $180.00 | $301.12 | $620.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,033.00
| Facility | | $1,395.00 | $2,384.00 | $5,033.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.81 / $430.37 / $666.98
| Professional | | $263.81 | $430.37 | $666.98 |