- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $5,200.07
| Facility | | $2,424.15 | $3,706.14 | $5,200.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.02 / $437.85 / $639.96
| Professional | | $385.02 | $437.85 | $639.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.29 / $512.51 / $812.17
| Professional | | $370.29 | $512.51 | $812.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.87 / $704.02 / $876.89
| Professional | | $533.87 | $704.02 | $876.89 |
- 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
- $378.62 / $607.84 / $921.32
| Professional | | $378.62 | $607.84 | $921.32 |