- 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
- $649.85 / $711.12 / $749.31
| Professional | | $649.85 | $711.12 | $749.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.47 / $765.26 / $1,280.65
| Professional | | $650.47 | $765.26 | $1,280.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.71 / $753.68 / $1,346.48
| Professional | | $508.71 | $753.68 | $1,346.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.06 / $659.72 / $1,013.48
| Professional | | $459.06 | $659.72 | $1,013.48 |