- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $2,388.83 / $3,224.92
| Facility | | $1,305.36 | $2,388.83 | $3,224.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.24 / $1,031.24 / $1,031.24
| Professional | | $1,031.24 | $1,031.24 | $1,031.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,958.06 / $1,958.06 / $1,958.06
| Facility | | $1,958.06 | $1,958.06 | $1,958.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.49 / $848.49 / $890.91
| Facility | | $848.49 | $848.49 | $890.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $2,228.23
| Professional | | $548.26 | $783.22 | $2,228.23 |