- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,466.84 / $7,079.46
| Facility | | $691.83 | $4,466.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $3,467.37
| Professional | | $758.58 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,344.23 / $8,912.51
| Facility | | $1,258.93 | $2,344.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,949.84 / $2,344.23
| Professional | | $1,778.28 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $10,232.93
| Facility | | $4,786.30 | $7,585.78 | $10,232.93 |