- 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
- $273.88 / $330.25 / $489.49
| Professional | | $273.88 | $330.25 | $489.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.20 / $398.86 / $625.27
| Professional | | $304.20 | $398.86 | $625.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.80 / $516.62 / $680.78
| Professional | | $390.80 | $516.62 | $680.78 |
- 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
- $270.69 / $445.36 / $709.30
| Professional | | $270.69 | $445.36 | $709.30 |