- 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
- $870.61 / $1,176.35 / $1,385.87
| Professional | | $870.61 | $1,176.35 | $1,385.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.88 / $1,154.15 / $1,760.02
| Professional | | $833.88 | $1,154.15 | $1,760.02 |
- 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
- $776.90 / $1,298.01 / $2,016.01
| Professional | | $776.90 | $1,298.01 | $2,016.01 |