- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.56 / $2,864.82 / $4,897.12
| Facility | | $2,448.56 | $2,864.82 | $4,897.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.88 / $2,864.82 / $2,864.82
| Professional | | $1,909.88 | $2,864.82 | $2,864.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.99 / $1,836.42 / $2,166.98
| Professional | | $1,511.99 | $1,836.42 | $2,166.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.56 / $1,989.45 / $5,299.89
| Facility | | $1,591.56 | $1,989.45 | $5,299.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.40 / $1,028.40 / $1,469.14
| Professional | | $1,028.40 | $1,028.40 | $1,469.14 |