- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $4,937.68
| Facility | | $3,706.14 | $3,955.04 | $4,937.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.27 / $843.70 / $1,004.99
| Professional | | $764.27 | $843.70 | $1,004.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.08 / $933.03 / $1,559.32
| Professional | | $793.08 | $933.03 | $1,559.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $1,028.85 / $1,646.97
| Professional | | $300.00 | $1,028.85 | $1,646.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,596.00 / $7,457.00 / $12,945.00
| Facility | | $4,596.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.13 / $1,084.70 / $1,749.31
| Professional | | $700.13 | $1,084.70 | $1,749.31 |