- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $8,029.74
| Facility | | $2,424.15 | $3,706.14 | $8,029.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.12 / $656.59 / $790.24
| Professional | | $575.12 | $656.59 | $790.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.63 / $808.49 / $1,151.22
| Professional | | $593.63 | $808.49 | $1,151.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.92 / $872.06 / $1,574.89
| Professional | | $696.92 | $872.06 | $1,574.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.29 / $982.26 / $1,460.41
| Professional | | $632.29 | $982.26 | $1,460.41 |