- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.78 / $509.26 / $1,438.06
| Facility | | $94.78 | $509.26 | $1,438.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.54 / $172.95 / $418.53
| Professional | | $165.54 | $172.95 | $418.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.10 / $193.10 / $655.00
| Professional | | $193.10 | $193.10 | $655.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.27 / $253.32 / $842.69
| Professional | | $167.27 | $253.32 | $842.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.64 / $428.53 / $428.53
| Professional | | $198.64 | $428.53 | $428.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.63 / $263.16 / $607.55
| Professional | | $139.63 | $263.16 | $607.55 |