- 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
- $500.14 / $680.94 / $846.02
| Professional | | $500.14 | $680.94 | $846.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.26 / $673.00 / $1,083.65
| Professional | | $516.26 | $673.00 | $1,083.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.68 / $895.70 / $1,157.79
| Professional | | $701.68 | $895.70 | $1,157.79 |
- 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
- $455.59 / $798.27 / $1,229.26
| Professional | | $455.59 | $798.27 | $1,229.26 |