- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.63 / $1,027.58 / $1,207.03
| Professional | | $737.63 | $1,027.58 | $1,207.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.87 / $981.13 / $1,508.10
| Professional | | $708.87 | $981.13 | $1,508.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.02 / $1,267.88 / $1,668.31
| Professional | | $1,022.02 | $1,267.88 | $1,668.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $7,819.00 / $19,195.00
| Facility | | $4,505.00 | $7,819.00 | $19,195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.04 / $1,040.53 / $1,710.76
| Professional | | $737.04 | $1,040.53 | $1,710.76 |