- 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
- $688.95 / $910.51 / $968.85
| Professional | | $688.95 | $910.51 | $968.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.47 / $1,031.14 / $1,533.17
| Professional | | $876.47 | $1,031.14 | $1,533.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.38 / $1,227.55 / $1,954.13
| Professional | | $901.38 | $1,227.55 | $1,954.13 |
- 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
- $748.04 / $1,054.40 / $1,765.33
| Professional | | $748.04 | $1,054.40 | $1,765.33 |