- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,301.91 / $3,301.91 / $5,348.46
| Facility | | $3,301.91 | $3,301.91 | $5,348.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.25 / $969.77 / $1,480.74
| Professional | | $804.25 | $969.77 | $1,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.53 / $1,259.85 / $1,793.10
| Professional | | $973.53 | $1,259.85 | $1,793.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.76 / $1,407.70 / $2,001.86
| Professional | | $955.76 | $1,407.70 | $2,001.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.06 / $1,354.92 / $2,078.51
| Professional | | $1,171.06 | $1,354.92 | $2,078.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,301.91 / $3,301.91 / $5,348.46
| Facility | | $3,301.91 | $3,301.91 | $5,348.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.25 / $1,173.07 / $1,742.14
| Professional | | $804.25 | $1,173.07 | $1,742.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.55 / $1,220.01 / $1,599.49
| Professional | | $884.55 | $1,220.01 | $1,599.49 |