- 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
- $358.32 / $501.37 / $795.56
| Professional | | $358.32 | $501.37 | $795.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.89 / $529.86 / $1,014.03
| Professional | | $397.89 | $529.86 | $1,014.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.04 / $745.43 / $1,089.46
| Professional | | $520.04 | $745.43 | $1,089.46 |
- 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
- $479.40 / $764.95 / $1,150.31
| Professional | | $479.40 | $764.95 | $1,150.31 |