- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.62 / $723.88 / $858.71
| Professional | | $533.62 | $723.88 | $858.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.44 / $703.73 / $993.80
| Professional | | $508.44 | $703.73 | $993.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.05 / $894.86 / $1,201.10
| Professional | | $733.05 | $894.86 | $1,201.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,219.00 / $7,228.00 / $12,680.00
| Facility | | $3,219.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.11 / $825.23 / $1,201.80
| Professional | | $504.11 | $825.23 | $1,201.80 |