- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.75 / $1,484.68 / $1,987.18
| Facility | | $970.75 | $1,484.68 | $1,987.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.75 / $993.59 / $1,313.37
| Professional | | $970.75 | $993.59 | $1,313.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.16 / $1,246.40 / $2,104.39
| Professional | | $1,199.16 | $1,246.40 | $2,104.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,573.02 / $2,205.48 / $2,722.16
| Facility | | $1,573.02 | $2,205.48 | $2,722.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.64 / $1,325.64 / $1,325.64
| Professional | | $1,325.64 | $1,325.64 | $1,325.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.75 / $1,370.47 / $5,424.79
| Facility | | $970.75 | $1,370.47 | $5,424.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.67 / $685.24 / $5,687.46
| Professional | | $479.67 | $685.24 | $5,687.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.67 / $685.24 / $1,291.67
| Professional | | $479.67 | $685.24 | $1,291.67 |