- 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
- $179.54 / $207.02 / $324.72
| Professional | | $179.54 | $207.02 | $324.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.60 / $238.81 / $418.10
| Professional | | $190.60 | $238.81 | $418.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.42 / $342.12 / $437.46
| Professional | | $256.42 | $342.12 | $437.46 |
- 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
- $189.98 / $306.95 / $474.28
| Professional | | $189.98 | $306.95 | $474.28 |