- 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
- $1,071.97 / $1,560.31 / $1,678.23
| Professional | | $1,071.97 | $1,560.31 | $1,678.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.07 / $1,707.14 / $2,742.09
| Professional | | $1,451.07 | $1,707.14 | $2,742.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $1,736.20 / $2,958.73
| Professional | | $300.00 | $1,736.20 | $2,958.73 |
- 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
- $1,147.40 / $2,027.95 / $3,113.31
| Professional | | $1,147.40 | $2,027.95 | $3,113.31 |