- 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
- $145.27 / $228.15 / $231.96
| Professional | | $145.27 | $228.15 | $231.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.53 / $219.41 / $328.33
| Professional | | $158.53 | $219.41 | $328.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.34 / $296.58 / $377.38
| Professional | | $220.34 | $296.58 | $377.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,199.00 / $4,915.00
| Facility | | $437.00 | $1,199.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.97 / $240.13 / $391.60
| Professional | | $161.97 | $240.13 | $391.60 |