- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,248.07 / $8,511.38
| Facility | | $2,511.89 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,570.88 / $5,623.41
| Professional | | $4,265.80 | $4,570.88 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,162.28 / $14,125.38
| Facility | | $3,090.30 | $3,162.28 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,248.07 / $19,054.61
| Facility | | $1,412.54 | $5,248.07 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $15,135.61
| Facility | | $3,162.28 | $4,786.30 | $15,135.61 |