- 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
- $128.72 / $193.55 / $260.25
| Professional | | $128.72 | $193.55 | $260.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.49 / $242.06 / $325.77
| Professional | | $151.49 | $242.06 | $325.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.31 / $250.86 / $408.92
| Professional | | $146.31 | $250.86 | $408.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.03 / $255.05 / $456.22
| Professional | | $173.03 | $255.05 | $456.22 |