- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.89 / $517.89 / $1,917.36
| Facility | | $517.89 | $517.89 | $1,917.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.89 / $1,607.70 / $2,272.21
| Professional | | $517.89 | $1,607.70 | $2,272.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.24 / $1,884.46 / $5,906.37
| Facility | | $1,832.24 | $1,884.46 | $5,906.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,033.32 / $2,463.13 / $3,922.27
| Professional | | $2,033.32 | $2,463.13 | $3,922.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.60 / $2,465.14 / $8,681.58
| Facility | | $2,143.60 | $2,465.14 | $8,681.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.05 / $2,108.03 / $2,569.56
| Professional | | $667.05 | $2,108.03 | $2,569.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.88 / $900.31 / $1,286.16
| Professional | | $252.88 | $900.31 | $1,286.16 |