- 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
- $429.23 / $607.02 / $613.02
| Professional | | $429.23 | $607.02 | $613.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.92 / $684.62 / $954.66
| Professional | | $581.92 | $684.62 | $954.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.97 / $734.83 / $1,345.29
| Professional | | $614.97 | $734.83 | $1,345.29 |
- 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
- $494.19 / $787.12 / $1,205.17
| Professional | | $494.19 | $787.12 | $1,205.17 |