- 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
- $259.51 / $361.28 / $462.22
| Professional | | $259.51 | $361.28 | $462.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.27 / $362.68 / $588.58
| Professional | | $274.27 | $362.68 | $588.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.89 / $469.06 / $624.72
| Professional | | $302.89 | $469.06 | $624.72 |
- 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
- $237.21 / $431.03 / $667.67
| Professional | | $237.21 | $431.03 | $667.67 |