- 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
- $393.16 / $462.96 / $588.52
| Professional | | $393.16 | $462.96 | $588.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.85 / $605.34 / $886.61
| Professional | | $457.85 | $605.34 | $886.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.65 / $656.87 / $1,169.35
| Professional | | $542.65 | $656.87 | $1,169.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.30 / $729.34 / $1,052.08
| Professional | | $439.30 | $729.34 | $1,052.08 |