- 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
- $304.79 / $422.77 / $528.02
| Professional | | $304.79 | $422.77 | $528.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.32 / $598.12 / $827.65
| Professional | | $426.32 | $598.12 | $827.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.93 / $733.73 / $1,048.40
| Professional | | $507.93 | $733.73 | $1,048.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.36 / $628.88 / $1,125.10
| Professional | | $410.36 | $628.88 | $1,125.10 |