- 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
- $461.68 / $645.46 / $739.50
| Professional | | $461.68 | $645.46 | $739.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.18 / $614.78 / $951.68
| Professional | | $444.18 | $614.78 | $951.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.40 / $828.55 / $1,025.61
| Professional | | $640.40 | $828.55 | $1,025.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.54 / $643.89 / $1,045.55
| Professional | | $443.54 | $643.89 | $1,045.55 |