- 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
- $432.28 / $539.29 / $678.55
| Professional | | $432.28 | $539.29 | $678.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.39 / $719.48 / $846.63
| Professional | | $511.39 | $719.48 | $846.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.57 / $598.41 / $1,238.64
| Professional | | $355.57 | $598.41 | $1,238.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.67 / $683.92 / $925.01
| Professional | | $448.67 | $683.92 | $925.01 |