- 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
- $148.91 / $154.91 / $205.51
| Professional | | $148.91 | $154.91 | $205.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.38 / $185.15 / $290.44
| Professional | | $157.38 | $185.15 | $290.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.26 / $219.93 / $306.08
| Professional | | $128.26 | $219.93 | $306.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.10 / $212.02 / $326.83
| Professional | | $154.10 | $212.02 | $326.83 |