- 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
- $407.38 / $512.86 / $1,380.38
| Professional | | $407.38 | $512.86 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $741.31
| Professional | | $331.13 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $575.44 / $891.25
| Professional | | $89.13 | $575.44 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $7,585.78
| Facility | | $2,570.40 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $831.76
| Professional | | $380.19 | $602.56 | $831.76 |