- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.83 / $1,543.03 / $3,955.04
| Facility | | $655.83 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.40 / $300.52 / $418.43
| Professional | | $171.40 | $300.52 | $418.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.22 / $331.09 / $576.87
| Professional | | $166.22 | $331.09 | $576.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.01 / $397.26 / $816.08
| Professional | | $197.01 | $397.26 | $816.08 |
- 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
- $296.14 / $509.61 / $863.50
| Professional | | $296.14 | $509.61 | $863.50 |