- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.22 / $878.63 / $1,080.26
| Professional | | $645.22 | $878.63 | $1,080.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.45 / $1,066.38 / $1,479.00
| Professional | | $750.45 | $1,066.38 | $1,479.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.67 / $1,150.86 / $2,057.44
| Professional | | $883.67 | $1,150.86 | $2,057.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.63 / $1,202.36 / $1,910.41
| Professional | | $803.63 | $1,202.36 | $1,910.41 |