- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,706.14 / $3,955.04
| Facility | | $3,706.14 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.92 / $1,001.51 / $1,194.50
| Professional | | $714.92 | $1,001.51 | $1,194.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.83 / $1,118.09 / $1,486.03
| Professional | | $807.83 | $1,118.09 | $1,486.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.06 / $1,292.84 / $1,927.28
| Professional | | $1,105.06 | $1,292.84 | $1,927.28 |
- 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
- $741.69 / $1,187.69 / $1,910.47
| Professional | | $741.69 | $1,187.69 | $1,910.47 |