- 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
- $918.17 / $1,319.19 / $1,544.71
| Professional | | $918.17 | $1,319.19 | $1,544.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.56 / $1,198.00 / $1,958.02
| Professional | | $865.56 | $1,198.00 | $1,958.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.91 / $1,676.42 / $2,121.52
| Professional | | $1,247.91 | $1,676.42 | $2,121.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,713.00 / $7,457.00 / $12,945.00
| Facility | | $3,713.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.85 / $1,470.56 / $2,221.16
| Professional | | $926.85 | $1,470.56 | $2,221.16 |