- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.06 / $822.54 / $825.65
| Professional | | $754.06 | $822.54 | $825.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.67 / $884.32 / $1,416.31
| Professional | | $751.67 | $884.32 | $1,416.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.82 / $874.55 / $1,558.63
| Professional | | $589.82 | $874.55 | $1,558.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.29 / $767.99 / $1,177.85
| Professional | | $533.29 | $767.99 | $1,177.85 |