- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.51 / $806.15 / $2,756.24
| Facility | | $324.51 | $806.15 | $2,756.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.68 / $313.68 / $357.00
| Professional | | $313.68 | $313.68 | $357.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.76 / $486.76 / $486.76
| Professional | | $486.76 | $486.76 | $486.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.23 / $1,315.23 / $2,722.46
| Facility | | $1,315.23 | $1,315.23 | $2,722.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.34 / $529.09 / $608.45
| Professional | | $511.34 | $529.09 | $608.45 |