- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,753.25 / $3,166.24 / $5,506.50
| Facility | | $2,753.25 | $3,166.24 | $5,506.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $3,166.24 / $3,166.24
| Professional | | $455.43 | $3,166.24 | $3,166.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.46 / $2,009.97 / $2,371.76
| Professional | | $545.46 | $2,009.97 | $2,371.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.82 / $2,237.01 / $5,959.40
| Facility | | $1,753.82 | $2,237.01 | $5,959.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,156.36 / $1,651.95
| Professional | | $1,156.36 | $1,156.36 | $1,651.95 |