- 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
- $193.65 / $254.35 / $264.93
| Professional | | $193.65 | $254.35 | $264.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.54 / $280.63 / $406.81
| Professional | | $238.54 | $280.63 | $406.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.61 / $318.08 / $510.00
| Professional | | $242.61 | $318.08 | $510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $4,915.00 / $7,205.00
| Facility | | $1,649.00 | $4,915.00 | $7,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.65 / $346.84 / $476.07
| Professional | | $208.65 | $346.84 | $476.07 |