- 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
- $931.30 / $1,311.37 / $1,557.72
| Professional | | $931.30 | $1,311.37 | $1,557.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.75 / $1,220.41 / $1,985.51
| Professional | | $881.75 | $1,220.41 | $1,985.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.17 / $1,606.14 / $2,151.39
| Professional | | $1,167.17 | $1,606.14 | $2,151.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.89 / $1,491.27 / $2,252.33
| Professional | | $829.89 | $1,491.27 | $2,252.33 |