- 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
- $57.01 / $59.63 / $100.72
| Professional | | $57.01 | $59.63 | $100.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.87 / $69.26 / $127.08
| Professional | | $58.87 | $69.26 | $127.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.27 / $97.94 / $131.85
| Professional | | $50.27 | $97.94 | $131.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.50 / $88.06 / $154.52
| Professional | | $51.50 | $88.06 | $154.52 |