- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.93 / $896.22 / $997.38
| Professional | | $736.93 | $896.22 | $997.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.32 / $702.73 / $1,709.14
| Professional | | $597.32 | $702.73 | $1,709.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.63 / $845.98 / $1,043.01
| Professional | | $476.63 | $845.98 | $1,043.01 |