- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.21 / $607.08 / $705.61
| Professional | | $506.21 | $607.08 | $705.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.02 / $708.26 / $1,133.27
| Professional | | $602.02 | $708.26 | $1,133.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.88 / $758.51 / $1,388.44
| Professional | | $634.88 | $758.51 | $1,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.01 / $745.52 / $1,253.47
| Professional | | $550.01 | $745.52 | $1,253.47 |