- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,955.04 / $7,118.35
| Facility | | $3,438.26 | $3,955.04 | $7,118.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.53 / $911.94 / $1,042.52
| Professional | | $653.53 | $911.94 | $1,042.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.22 / $859.82 / $1,357.37
| Professional | | $621.22 | $859.82 | $1,357.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.65 / $1,131.93 / $1,467.18
| Professional | | $895.65 | $1,131.93 | $1,467.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.00 / $4,374.00 / $9,622.00
| Facility | | $2,299.00 | $4,374.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.67 / $915.08 / $1,539.76
| Professional | | $633.67 | $915.08 | $1,539.76 |