- 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
- $566.74 / $779.03 / $911.06
| Professional | | $566.74 | $779.03 | $911.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.66 / $731.71 / $1,188.71
| Professional | | $528.66 | $731.71 | $1,188.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.21 / $1,014.13 / $1,293.45
| Professional | | $762.21 | $1,014.13 | $1,293.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,219.00 / $7,228.00 / $12,680.00
| Facility | | $3,219.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.09 / $896.57 / $1,348.44
| Professional | | $556.09 | $896.57 | $1,348.44 |