- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,706.14 / $3,955.04
| Facility | | $3,706.14 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.40 / $254.11 / $377.03
| Professional | | $150.40 | $254.11 | $377.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.47 / $307.94 / $451.54
| Professional | | $172.47 | $307.94 | $451.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.03 / $343.79 / $517.29
| Professional | | $243.03 | $343.79 | $517.29 |
- 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
- $222.43 / $336.16 / $550.15
| Professional | | $222.43 | $336.16 | $550.15 |