- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $208.93 / $524.81
| Professional | | $194.98 | $208.93 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $169.82 / $346.74
| Professional | | $144.54 | $169.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $398.11
| Professional | | $151.36 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,128.61 / $10,000.00
| Facility | | $2,818.38 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $323.59
| Professional | | $134.90 | $204.17 | $323.59 |