- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $8,374.37
| Facility | | $2,090.73 | $3,706.14 | $8,374.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.09 / $504.54 / $793.63
| Professional | | $356.09 | $504.54 | $793.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.74 / $475.21 / $999.10
| Professional | | $373.74 | $475.21 | $999.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.62 / $689.86 / $985.65
| Professional | | $489.62 | $689.86 | $985.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $3,912.00 / $7,350.00
| Facility | | $2,080.00 | $3,912.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.46 / $622.55 / $1,097.56
| Professional | | $425.46 | $622.55 | $1,097.56 |