- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,370.32 / $7,413.10
| Facility | | $2,884.03 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,248.07 / $7,585.78
| Professional | | $4,570.88 | $5,248.07 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,801.89 / $7,244.36
| Facility | | $1,230.27 | $3,801.89 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $213.80 / $213.80
| Professional | | $177.83 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,456.54 / $17,378.01
| Facility | | $1,819.70 | $6,456.54 | $17,378.01 |