- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.13 / $2,596.38 / $4,438.26
| Facility | | $2,219.13 | $2,596.38 | $4,438.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.38 / $2,596.38 / $2,596.38
| Professional | | $2,596.38 | $2,596.38 | $2,596.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.43 / $1,803.04 / $4,803.29
| Facility | | $1,442.43 | $1,803.04 | $4,803.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.86 / $2,549.86 / $3,187.33
| Professional | | $2,549.86 | $2,549.86 | $3,187.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.03 / $932.03 / $2,219.13
| Professional | | $932.03 | $932.03 | $2,219.13 |