- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.03 / $2,048.17 / $2,532.92
| Facility | | $1,543.03 | $2,048.17 | $2,532.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.12 / $194.28 / $356.94
| Professional | | $94.12 | $194.28 | $356.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.08 / $229.91 / $386.19
| Professional | | $104.08 | $229.91 | $386.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.57 / $204.46 / $527.13
| Professional | | $145.57 | $204.46 | $527.13 |
- 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
- $229.79 / $328.78 / $569.39
| Professional | | $229.79 | $328.78 | $569.39 |