- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $5,496.04
| Facility | | $3,706.14 | $3,955.04 | $5,496.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.63 / $972.86 / $1,326.56
| Professional | | $941.63 | $972.86 | $1,326.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.43 / $1,292.27 / $2,102.42
| Professional | | $1,098.43 | $1,292.27 | $2,102.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $1,565.09 / $2,249.26
| Professional | | $250.00 | $1,565.09 | $2,249.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,599.00 / $7,228.00 / $12,680.00
| Facility | | $3,599.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.49 / $1,537.69 / $2,374.29
| Professional | | $1,021.49 | $1,537.69 | $2,374.29 |