- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.65 / $585.03 / $735.97
| Professional | | $418.65 | $585.03 | $735.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.63 / $906.61 / $1,115.82
| Professional | | $634.63 | $906.61 | $1,115.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.46 / $1,074.88 / $1,644.51
| Professional | | $495.46 | $1,074.88 | $1,644.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.73 / $975.49 / $1,615.21
| Professional | | $534.73 | $975.49 | $1,615.21 |