- 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
- $546.77 / $764.02 / $877.57
| Professional | | $546.77 | $764.02 | $877.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.57 / $723.28 / $1,133.19
| Professional | | $522.57 | $723.28 | $1,133.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.41 / $985.05 / $1,227.08
| Professional | | $753.41 | $985.05 | $1,227.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.11 / $840.14 / $1,285.48
| Professional | | $542.11 | $840.14 | $1,285.48 |