- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.78 / $2,090.73 / $3,955.04
| Facility | | $495.78 | $2,090.73 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.36 / $508.15 / $695.78
| Professional | | $322.36 | $508.15 | $695.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.98 / $607.09 / $945.32
| Professional | | $366.98 | $607.09 | $945.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.39 / $712.63 / $1,359.18
| Professional | | $370.39 | $712.63 | $1,359.18 |
- 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
- $543.94 / $746.33 / $1,246.39
| Professional | | $543.94 | $746.33 | $1,246.39 |