- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.82 / $132.82 / $214.41
| Facility | | $132.82 | $132.82 | $214.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.47 / $164.54 / $214.41
| Professional | | $127.47 | $164.54 | $214.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,431.23 / $2,950.43 / $3,969.27
| Facility | | $2,431.23 | $2,950.43 | $3,969.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.28 / $171.61 / $202.50
| Professional | | $125.28 | $171.61 | $202.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.56 / $3,138.00 / $4,884.05
| Facility | | $327.56 | $3,138.00 | $4,884.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.13 / $232.20 / $524.55
| Professional | | $134.13 | $232.20 | $524.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,282.72 / $4,165.18 / $4,871.14
| Facility | | $3,282.72 | $4,165.18 | $4,871.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.11 / $179.37 / $522.64
| Professional | | $138.11 | $179.37 | $522.64 |