- 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
- $252.21 / $322.56 / $384.10
| Professional | | $252.21 | $322.56 | $384.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.02 / $364.19 / $539.57
| Professional | | $294.02 | $364.19 | $539.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.46 / $329.51 / $631.46
| Professional | | $204.46 | $329.51 | $631.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,517.00 / $4,602.00
| Facility | | $1,388.00 | $2,517.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.73 / $316.55 / $482.09
| Professional | | $208.73 | $316.55 | $482.09 |