- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.21 / $3,706.14 / $3,955.04
| Facility | | $1,501.21 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.58 / $486.51 / $794.71
| Professional | | $335.58 | $486.51 | $794.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.33 / $533.37 / $992.00
| Professional | | $375.33 | $533.37 | $992.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.13 / $643.57 / $1,088.73
| Professional | | $493.13 | $643.57 | $1,088.73 |
- 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
- $460.90 / $675.75 / $1,159.25
| Professional | | $460.90 | $675.75 | $1,159.25 |