- 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
- $78.81 / $160.80 / $281.45
| Professional | | $78.81 | $160.80 | $281.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.31 / $178.39 / $293.20
| Professional | | $96.31 | $178.39 | $293.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.10 / $178.50 / $375.93
| Professional | | $123.10 | $178.50 | $375.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,445.00 / $4,602.00
| Facility | | $1,334.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.16 / $260.74 / $431.63
| Professional | | $163.16 | $260.74 | $431.63 |