- 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
- $61.00 / $109.00 / $190.06
| Professional | | $61.00 | $109.00 | $190.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.70 / $130.02 / $182.73
| Professional | | $72.70 | $130.02 | $182.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.10 / $132.69 / $269.52
| Professional | | $101.10 | $132.69 | $269.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.38 / $172.04 / $301.69
| Professional | | $102.38 | $172.04 | $301.69 |