- 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
- $388.58 / $533.78 / $621.95
| Professional | | $388.58 | $533.78 | $621.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.48 / $515.54 / $800.31
| Professional | | $372.48 | $515.54 | $800.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $660.06 / $864.77
| Professional | | $537.03 | $660.06 | $864.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.37 / $515.70 / $907.86
| Professional | | $374.37 | $515.70 | $907.86 |