- 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
- $205.52 / $290.33 / $402.97
| Professional | | $205.52 | $290.33 | $402.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.93 / $392.59 / $479.08
| Professional | | $243.93 | $392.59 | $479.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.35 / $413.30 / $720.88
| Professional | | $174.35 | $413.30 | $720.88 |
- 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
- $304.12 / $456.85 / $754.60
| Professional | | $304.12 | $456.85 | $754.60 |