- 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
- $864.70 / $1,084.61 / $1,414.93
| Professional | | $864.70 | $1,084.61 | $1,414.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.07 / $1,136.42 / $1,703.64
| Professional | | $821.07 | $1,136.42 | $1,703.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,183.78 / $1,566.30 / $1,951.48
| Professional | | $1,183.78 | $1,566.30 | $1,951.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,219.00 / $7,228.00 / $12,680.00
| Facility | | $3,219.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.21 / $1,352.71 / $1,941.98
| Professional | | $828.21 | $1,352.71 | $1,941.98 |