- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.90 / $309.26 / $423.92
| Professional | | $248.90 | $309.26 | $423.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.68 / $403.70 / $560.04
| Professional | | $291.68 | $403.70 | $560.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.66 / $441.36 / $1,034.29
| Professional | | $405.66 | $441.36 | $1,034.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.57 / $407.56 / $715.73
| Professional | | $230.57 | $407.56 | $715.73 |