- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,706.14 / $3,955.04
| Facility | | $3,706.14 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.20 / $1,015.85 / $1,060.83
| Professional | | $681.20 | $1,015.85 | $1,060.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.70 / $1,050.23 / $1,760.17
| Professional | | $892.70 | $1,050.23 | $1,760.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $1,186.54 / $1,877.35
| Professional | | $600.00 | $1,186.54 | $1,877.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $4,915.00 / $7,205.00
| Facility | | $1,649.00 | $4,915.00 | $7,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.97 / $1,284.04 / $1,971.55
| Professional | | $796.97 | $1,284.04 | $1,971.55 |