- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.63 / $236.21 / $444.48
| Professional | | $211.63 | $236.21 | $444.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.20 / $305.60 / $382.00
| Professional | | $229.20 | $305.60 | $382.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.33 / $336.69 / $747.43
| Facility | | $224.33 | $336.69 | $747.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,713.22 / $2,713.22 / $2,713.22
| Professional | | $2,713.22 | $2,713.22 | $2,713.22 |