- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.84 / $111.24 / $148.18
| Professional | | $77.84 | $111.24 | $148.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.05 / $126.26 / $208.63
| Professional | | $88.05 | $126.26 | $208.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.26 / $158.56 / $298.26
| Professional | | $90.26 | $158.56 | $298.26 |
- 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
- $108.10 / $175.70 / $320.50
| Professional | | $108.10 | $175.70 | $320.50 |