- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,041.74 / $3,235.94
| Facility | | $1,905.46 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $1,000.00
| Professional | | $309.03 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $363.08 / $588.84
| Professional | | $323.59 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $616.60 / $724.44
| Professional | | $398.11 | $616.60 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $7,585.78
| Facility | | $2,570.40 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $776.25
| Professional | | $309.03 | $467.74 | $776.25 |