- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $245.47 / $537.03
| Professional | | $104.71 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $208.93 / $398.11
| Professional | | $93.33 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $223.87 / $575.44
| Professional | | $125.89 | $223.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $234.42 / $512.86
| Professional | | $109.65 | $234.42 | $512.86 |