- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.80 / $2,387.17 / $4,151.60
| Facility | | $2,075.80 | $2,387.17 | $4,151.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,387.17 / $2,387.17 / $2,387.17
| Professional | | $2,387.17 | $2,387.17 | $2,387.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.51 / $9.11 / $12.26
| Facility | | $7.51 | $9.11 | $12.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.62 / $1,754.05 / $6,509.54
| Facility | | $1,632.62 | $1,754.05 | $6,509.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.08 / $2,385.08 / $2,981.34
| Professional | | $2,385.08 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $1,037.90 / $2,075.80
| Professional | | $871.84 | $1,037.90 | $2,075.80 |