- 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
- $280.41 / $624.79 / $1,051.46
| Professional | | $280.41 | $624.79 | $1,051.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.48 / $378.46 / $1,056.38
| Professional | | $258.48 | $378.46 | $1,056.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.82 / $811.32 / $1,194.35
| Professional | | $359.82 | $811.32 | $1,194.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.27 / $940.42 / $1,553.38
| Professional | | $553.27 | $940.42 | $1,553.38 |