- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.68 / $117.68 / $138.49
| Professional | | $117.68 | $117.68 | $138.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.72 / $165.32 / $229.18
| Professional | | $115.72 | $165.32 | $229.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.22 / $165.95 / $201.78
| Professional | | $94.22 | $165.95 | $201.78 |