- 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
- $479.37 / $641.50 / $744.48
| Professional | | $479.37 | $641.50 | $744.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.31 / $568.60 / $1,328.32
| Professional | | $483.31 | $568.60 | $1,328.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.71 / $800.10 / $1,939.73
| Professional | | $410.71 | $800.10 | $1,939.73 |
- 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
- $587.17 / $701.32 / $1,090.58
| Professional | | $587.17 | $701.32 | $1,090.58 |