- 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
- $152.53 / $185.65 / $251.51
| Professional | | $152.53 | $185.65 | $251.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.34 / $232.80 / $340.45
| Professional | | $144.34 | $232.80 | $340.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.93 / $262.33 / $499.73
| Professional | | $176.93 | $262.33 | $499.73 |
- 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
- $200.37 / $311.68 / $535.91
| Professional | | $200.37 | $311.68 | $535.91 |