- 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
- $132.46 / $150.53 / $218.25
| Professional | | $132.46 | $150.53 | $218.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.24 / $233.27 / $246.76
| Professional | | $156.24 | $233.27 | $246.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.25 / $188.70 / $396.55
| Professional | | $108.25 | $188.70 | $396.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.29 / $195.80 / $292.11
| Professional | | $141.29 | $195.80 | $292.11 |