- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,414.46 / $3,955.04 / $8,728.24
| Facility | | $3,414.46 | $3,955.04 | $8,728.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.77 / $699.32 / $1,089.49
| Professional | | $530.77 | $699.32 | $1,089.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.80 / $751.44 / $1,403.82
| Professional | | $583.80 | $751.44 | $1,403.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.93 / $975.24 / $1,490.81
| Professional | | $764.93 | $975.24 | $1,490.81 |
- 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
- $638.79 / $949.16 / $1,592.46
| Professional | | $638.79 | $949.16 | $1,592.46 |