- 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
- $186.96 / $223.45 / $279.08
| Professional | | $186.96 | $223.45 | $279.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.74 / $297.81 / $400.31
| Professional | | $202.74 | $297.81 | $400.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.13 / $322.01 / $581.84
| Professional | | $238.13 | $322.01 | $581.84 |
- 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
- $215.25 / $362.89 / $623.36
| Professional | | $215.25 | $362.89 | $623.36 |