- 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
- $310.11 / $421.44 / $524.33
| Professional | | $310.11 | $421.44 | $524.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.87 / $417.97 / $675.06
| Professional | | $325.87 | $417.97 | $675.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.34 / $554.03 / $718.92
| Professional | | $441.34 | $554.03 | $718.92 |
- 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
- $293.26 / $511.25 / $765.76
| Professional | | $293.26 | $511.25 | $765.76 |