- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $25,850.91
| Facility | | $1,518.41 | $3,706.14 | $25,850.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.16 / $159.63 / $246.29
| Professional | | $119.16 | $159.63 | $246.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.56 / $170.49 / $267.63
| Professional | | $121.56 | $170.49 | $267.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.66 / $237.02 / $304.89
| Professional | | $160.66 | $237.02 | $304.89 |
- 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
- $132.80 / $219.33 / $339.77
| Professional | | $132.80 | $219.33 | $339.77 |