- 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
- $244.78 / $333.24 / $430.70
| Professional | | $244.78 | $333.24 | $430.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.89 / $282.33 / $576.55
| Professional | | $220.89 | $282.33 | $576.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.02 / $464.81 / $595.20
| Professional | | $310.02 | $464.81 | $595.20 |
- 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
- $245.94 / $412.56 / $654.04
| Professional | | $245.94 | $412.56 | $654.04 |