- 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
- $383.14 / $681.85 / $2,513.21
| Professional | | $383.14 | $681.85 | $2,513.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.83 / $1,403.91 / $2,197.42
| Professional | | $476.83 | $1,403.91 | $2,197.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.41 / $889.65 / $3,714.93
| Professional | | $330.41 | $889.65 | $3,714.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.07 / $2,575.06 / $4,005.55
| Professional | | $1,847.07 | $2,575.06 | $4,005.55 |