- 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
- $568.75 / $794.43 / $919.83
| Professional | | $568.75 | $794.43 | $919.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.27 / $751.93 / $1,179.58
| Professional | | $543.27 | $751.93 | $1,179.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,164.00 / $11,950.00
| Facility | | $2,838.00 | $5,164.00 | $11,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.29 / $883.82 / $1,338.09
| Professional | | $563.29 | $883.82 | $1,338.09 |