- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $3,981.07
| Facility | | $3,019.95 | $3,715.35 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $407.38 / $1,071.52
| Professional | | $354.81 | $407.38 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $407.38 / $676.08
| Professional | | $363.08 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $831.76
| Professional | | $457.09 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $870.96
| Professional | | $346.74 | $489.78 | $870.96 |