- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.63 / $1,342.00 / $3,109.00
| Facility | | $157.63 | $1,342.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.63 / $158.27 / $239.05
| Professional | | $157.63 | $158.27 | $239.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.25 / $286.22 / $286.22
| Professional | | $216.25 | $286.22 | $286.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.13 / $329.52 / $408.43
| Professional | | $208.13 | $329.52 | $408.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.69 / $228.85 / $439.48
| Professional | | $170.69 | $228.85 | $439.48 |