- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,884.03 / $6,456.54
| Facility | | $2,818.38 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $794.33 / $1,174.90
| Professional | | $173.78 | $794.33 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $281.84 / $812.83
| Professional | | $151.36 | $281.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $1,949.84
| Professional | | $776.25 | $1,122.02 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $2,187.76
| Facility | | $1,174.90 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $1,071.52 / $1,778.28
| Professional | | $131.83 | $1,071.52 | $1,778.28 |