- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.48 / $594.86 / $619.91
| Professional | | $337.48 | $594.86 | $619.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.54 / $637.11 / $982.83
| Professional | | $541.54 | $637.11 | $982.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.20 / $765.02 / $1,434.69
| Professional | | $403.20 | $765.02 | $1,434.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.80 / $685.95 / $1,096.71
| Professional | | $477.80 | $685.95 | $1,096.71 |