- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.54 / $617.02 / $837.51
| Professional | | $601.54 | $617.02 | $837.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.36 / $822.78 / $1,334.72
| Professional | | $699.36 | $822.78 | $1,334.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $956.33 / $1,420.14
| Professional | | $250.00 | $956.33 | $1,420.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.50 / $972.79 / $1,503.75
| Professional | | $620.50 | $972.79 | $1,503.75 |