- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.74 / $1,794.24 / $2,516.64
| Professional | | $1,016.74 | $1,794.24 | $2,516.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.09 / $1,850.09 / $3,061.15
| Facility | | $1,850.09 | $1,850.09 | $3,061.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,344.05 / $1,850.09 / $4,560.93
| Professional | | $1,344.05 | $1,850.09 | $4,560.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $457.17
| Professional | | $100.00 | $200.00 | $457.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.91 / $471.87 / $3,285.14
| Professional | | $353.91 | $471.87 | $3,285.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.14 / $2,204.60 / $3,053.04
| Professional | | $1,555.14 | $2,204.60 | $3,053.04 |