- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $3,981.07
| Facility | | $2,089.30 | $2,754.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $208.93 / $478.63
| Professional | | $169.82 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $190.55 / $309.03
| Professional | | $144.54 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $245.47 / $371.54
| Professional | | $89.13 | $245.47 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $229.09 / $371.54
| Professional | | $162.18 | $229.09 | $371.54 |