- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $3,981.07
| Facility | | $2,398.83 | $3,235.94 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $977.24 / $1,445.44
| Professional | | $371.54 | $977.24 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $602.56 / $1,071.52
| Professional | | $309.03 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $707.95 / $1,862.09
| Professional | | $281.84 | $707.95 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,128.61 / $10,000.00
| Facility | | $2,818.38 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $758.58 / $1,513.56
| Professional | | $389.05 | $758.58 | $1,513.56 |