- 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
- $153.66 / $281.52 / $496.74
| Professional | | $153.66 | $281.52 | $496.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.02 / $319.68 / $512.33
| Professional | | $169.02 | $319.68 | $512.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.83 / $330.31 / $621.86
| Professional | | $212.83 | $330.31 | $621.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.58 / $473.76 / $787.79
| Professional | | $298.58 | $473.76 | $787.79 |