- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.59 / $1,095.31 / $3,992.45
| Facility | | $804.59 | $1,095.31 | $3,992.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $903.27 / $986.77
| Professional | | $455.43 | $903.27 | $986.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.05 / $759.05 / $759.05
| Facility | | $759.05 | $759.05 | $759.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.38 / $5,361.14 / $5,763.11
| Facility | | $493.38 | $5,361.14 | $5,763.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $408.70 / $1,138.58
| Professional | | $318.80 | $408.70 | $1,138.58 |