- 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
- $288.17 / $356.32 / $520.01
| Professional | | $288.17 | $356.32 | $520.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.14 / $403.93 / $664.08
| Professional | | $315.14 | $403.93 | $664.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.70 / $545.70 / $712.65
| Professional | | $424.70 | $545.70 | $712.65 |
- 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
- $278.32 / $427.76 / $736.25
| Professional | | $278.32 | $427.76 | $736.25 |