- 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
- $109.11 / $185.55 / $254.85
| Professional | | $109.11 | $185.55 | $254.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.76 / $283.73 / $473.69
| Professional | | $169.76 | $283.73 | $473.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.10 / $299.10 / $591.91
| Professional | | $191.10 | $299.10 | $591.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.32 / $410.30 / $635.70
| Professional | | $146.32 | $410.30 | $635.70 |