- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.22 / $1,213.94 / $1,426.02
| Professional | | $864.22 | $1,213.94 | $1,426.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.10 / $1,135.08 / $1,818.07
| Professional | | $820.10 | $1,135.08 | $1,818.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.38 / $1,525.29 / $1,960.09
| Professional | | $1,182.38 | $1,525.29 | $1,960.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.00 / $6,315.00 / $12,945.00
| Facility | | $3,007.00 | $6,315.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.43 / $1,358.67 / $2,062.40
| Professional | | $845.43 | $1,358.67 | $2,062.40 |