- 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
- $928.36 / $1,209.44 / $1,301.88
| Professional | | $928.36 | $1,209.44 | $1,301.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $2,430.03 / $2,430.03
| Professional | | $0.02 | $2,430.03 | $2,430.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.70 / $1,441.34 / $2,614.96
| Professional | | $1,196.70 | $1,441.34 | $2,614.96 |
- 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
- $922.70 / $1,630.96 / $2,661.81
| Professional | | $922.70 | $1,630.96 | $2,661.81 |