- 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
- $656.82 / $915.91 / $1,050.08
| Professional | | $656.82 | $915.91 | $1,050.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.42 / $864.26 / $1,363.58
| Professional | | $624.42 | $864.26 | $1,363.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.27 / $1,134.94 / $1,473.02
| Professional | | $900.27 | $1,134.94 | $1,473.02 |
- 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
- $636.28 / $1,021.04 / $1,546.82
| Professional | | $636.28 | $1,021.04 | $1,546.82 |