- 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
- $710.10 / $990.28 / $1,336.78
| Professional | | $710.10 | $990.28 | $1,336.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.99 / $944.86 / $1,694.45
| Professional | | $766.99 | $944.86 | $1,694.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.07 / $1,285.06 / $1,817.10
| Professional | | $994.07 | $1,285.06 | $1,817.10 |
- 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
- $635.72 / $1,251.55 / $1,922.16
| Professional | | $635.72 | $1,251.55 | $1,922.16 |