- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.51 / $5,452.63 / $6,733.88
| Facility | | $821.51 | $5,452.63 | $6,733.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.29 / $821.51 / $970.05
| Professional | | $742.29 | $821.51 | $970.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.00 / $1,100.00 / $1,815.00
| Professional | | $990.00 | $1,100.00 | $1,815.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.72 / $2,430.17 / $4,109.95
| Professional | | $996.72 | $2,430.17 | $4,109.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.61 / $2,041.34 / $2,041.34
| Professional | | $941.61 | $2,041.34 | $2,041.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.91 / $1,205.36 / $2,667.96
| Professional | | $713.91 | $1,205.36 | $2,667.96 |