- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.45 / $233.70 / $289.54
| Professional | | $174.45 | $233.70 | $289.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.05 / $238.13 / $391.48
| Professional | | $172.05 | $238.13 | $391.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.13 / $327.98 / $407.40
| Professional | | $239.13 | $327.98 | $407.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.98 / $273.38 / $435.79
| Professional | | $170.98 | $273.38 | $435.79 |