- 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
- $119.33 / $183.30 / $239.08
| Professional | | $119.33 | $183.30 | $239.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.44 / $268.83 / $319.33
| Professional | | $172.44 | $268.83 | $319.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.31 / $263.63 / $441.15
| Professional | | $148.31 | $263.63 | $441.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.15 / $301.35 / $471.51
| Professional | | $166.15 | $301.35 | $471.51 |