- 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
- $304.16 / $571.26 / $630.24
| Professional | | $304.16 | $571.26 | $630.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.35 / $595.70 / $1,000.92
| Professional | | $506.35 | $595.70 | $1,000.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.44 / $737.17 / $1,344.36
| Professional | | $390.44 | $737.17 | $1,344.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.63 / $655.04 / $1,024.10
| Professional | | $479.63 | $655.04 | $1,024.10 |