- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.30 / $171.01 / $368.96
| Professional | | $106.30 | $171.01 | $368.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.97 / $242.56 / $321.56
| Professional | | $147.97 | $242.56 | $321.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $279.83 / $547.36
| Professional | | $150.00 | $279.83 | $547.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.34 / $471.70 / $817.88
| Professional | | $218.34 | $471.70 | $817.88 |