- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.49 / $654.52 / $1,008.69
| Professional | | $456.49 | $654.52 | $1,008.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.28 / $668.68 / $1,305.58
| Professional | | $497.28 | $668.68 | $1,305.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.32 / $908.62 / $1,359.41
| Professional | | $639.32 | $908.62 | $1,359.41 |
- 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
- $598.74 / $957.05 / $1,470.45
| Professional | | $598.74 | $957.05 | $1,470.45 |