- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,456.54 / $6,456.54
| Facility | | $3,801.89 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $501.19 / $1,479.11
| Professional | | $281.84 | $501.19 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $1,584.89
| Professional | | $524.81 | $524.81 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $549.54 / $776.25
| Professional | | $309.03 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $724.44
| Professional | | $436.52 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $537.03 / $1,023.29
| Professional | | $407.38 | $537.03 | $1,023.29 |