- 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
- $825.22 / $1,075.33 / $1,157.63
| Professional | | $825.22 | $1,075.33 | $1,157.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $2,159.69 / $2,159.69
| Professional | | $0.02 | $2,159.69 | $2,159.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.25 / $1,281.23 / $2,324.26
| Professional | | $1,063.25 | $1,281.23 | $2,324.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.65 / $1,386.09 / $2,151.67
| Professional | | $794.65 | $1,386.09 | $2,151.67 |