- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.72 / $629.38 / $943.09
| Professional | | $467.72 | $629.38 | $943.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.38 / $603.13 / $1,193.29
| Professional | | $491.38 | $603.13 | $1,193.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.35 / $879.49 / $1,189.72
| Professional | | $585.35 | $879.49 | $1,189.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.67 / $824.68 / $1,353.64
| Professional | | $426.67 | $824.68 | $1,353.64 |