- 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
- $425.79 / $620.48 / $827.52
| Professional | | $425.79 | $620.48 | $827.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.98 / $878.52 / $1,061.91
| Professional | | $640.98 | $878.52 | $1,061.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.41 / $733.04 / $1,507.22
| Professional | | $448.41 | $733.04 | $1,507.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.75 / $753.55 / $1,133.41
| Professional | | $472.75 | $753.55 | $1,133.41 |