- 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
- $284.73 / $429.56 / $680.25
| Professional | | $284.73 | $429.56 | $680.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.89 / $491.44 / $843.83
| Professional | | $314.89 | $491.44 | $843.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.75 / $629.54 / $931.45
| Professional | | $457.75 | $629.54 | $931.45 |
- 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
- $423.72 / $684.76 / $1,014.72
| Professional | | $423.72 | $684.76 | $1,014.72 |