- 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
- $289.97 / $437.31 / $687.00
| Professional | | $289.97 | $437.31 | $687.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.33 / $505.33 / $869.62
| Professional | | $324.33 | $505.33 | $869.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.78 / $626.07 / $946.80
| Professional | | $471.78 | $626.07 | $946.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.62 / $696.67 / $1,045.35
| Professional | | $399.62 | $696.67 | $1,045.35 |