- 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
- $381.59 / $518.32 / $613.96
| Professional | | $381.59 | $518.32 | $613.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.82 / $557.54 / $774.24
| Professional | | $402.82 | $557.54 | $774.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.49 / $681.24 / $857.16
| Professional | | $561.49 | $681.24 | $857.16 |
- 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
- $340.82 / $594.15 / $878.28
| Professional | | $340.82 | $594.15 | $878.28 |