- 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
- $389.83 / $526.08 / $607.12
| Professional | | $389.83 | $526.08 | $607.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.21 / $586.13 / $944.01
| Professional | | $498.21 | $586.13 | $944.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $616.60 / $1,023.59
| Professional | | $200.00 | $616.60 | $1,023.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.78 / $709.52 / $1,088.90
| Professional | | $419.78 | $709.52 | $1,088.90 |