- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.63 / $326.18 / $390.40
| Professional | | $238.63 | $326.18 | $390.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.10 / $312.94 / $506.55
| Professional | | $226.10 | $312.94 | $506.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.97 / $427.47 / $536.32
| Professional | | $325.97 | $427.47 | $536.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.84 / $369.02 / $574.61
| Professional | | $211.84 | $369.02 | $574.61 |