- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.39 / $1,049.36 / $5,441.52
| Professional | | $592.39 | $1,049.36 | $5,441.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.46 / $1,416.46 / $1,416.46
| Facility | | $1,416.46 | $1,416.46 | $1,416.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.63 / $957.31 / $1,901.50
| Professional | | $402.63 | $957.31 | $1,901.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.46 / $1,416.46 / $1,416.46
| Facility | | $1,416.46 | $1,416.46 | $1,416.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.63 / $957.31 / $1,901.50
| Professional | | $402.63 | $957.31 | $1,901.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.65 / $846.27 / $3,808.22
| Professional | | $369.65 | $846.27 | $3,808.22 |