- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.87 / $1,543.03 / $3,955.04
| Facility | | $1,400.87 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.47 / $172.85 / $233.13
| Professional | | $127.47 | $172.85 | $233.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.35 / $143.19 / $281.45
| Professional | | $90.35 | $143.19 | $281.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.17 / $174.85 / $293.08
| Professional | | $124.17 | $174.85 | $293.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.30 / $229.89 / $351.18
| Professional | | $127.30 | $229.89 | $351.18 |