- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,764.61 / $5,764.61 / $6,557.09
| Facility | | $5,764.61 | $5,764.61 | $6,557.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.65 / $325.64 / $654.52
| Professional | | $233.65 | $325.64 | $654.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.20 / $432.66 / $620.27
| Professional | | $315.20 | $432.66 | $620.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.75 / $503.90 / $807.93
| Professional | | $319.75 | $503.90 | $807.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.68 / $508.33 / $847.36
| Professional | | $360.68 | $508.33 | $847.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,764.61 / $5,764.61 / $6,557.09
| Facility | | $5,764.61 | $5,764.61 | $6,557.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.65 / $336.82 / $654.52
| Professional | | $233.65 | $336.82 | $654.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.26 / $560.72 / $816.71
| Professional | | $391.26 | $560.72 | $816.71 |