- 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
- $658.33 / $910.71 / $1,076.71
| Professional | | $658.33 | $910.71 | $1,076.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.74 / $866.08 / $1,371.44
| Professional | | $625.74 | $866.08 | $1,371.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.16 / $1,121.16 / $1,480.03
| Professional | | $902.16 | $1,121.16 | $1,480.03 |
- 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
- $658.46 / $1,025.91 / $1,555.74
| Professional | | $658.46 | $1,025.91 | $1,555.74 |