- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $3,981.07
| Facility | | $2,398.83 | $3,235.94 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $1,318.26
| Professional | | $426.58 | $478.63 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $489.78 / $812.83
| Professional | | $436.52 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $691.83 / $1,000.00
| Professional | | $537.03 | $691.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $1,047.13
| Professional | | $398.11 | $549.54 | $1,047.13 |