- 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
- $129.41 / $175.25 / $241.46
| Professional | | $129.41 | $175.25 | $241.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.72 / $236.14 / $517.48
| Professional | | $200.72 | $236.14 | $517.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.46 / $274.02 / $417.93
| Professional | | $187.46 | $274.02 | $417.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $4,915.00 / $7,205.00
| Facility | | $1,649.00 | $4,915.00 | $7,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.91 / $265.22 / $404.74
| Professional | | $217.91 | $265.22 | $404.74 |