- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.01 / $1,062.58 / $1,150.53
| Professional | | $704.01 | $1,062.58 | $1,150.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.17 / $998.17 / $1,550.07
| Professional | | $721.17 | $998.17 | $1,550.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.76 / $1,277.29 / $1,698.26
| Professional | | $1,039.76 | $1,277.29 | $1,698.26 |
- 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
- $729.69 / $1,177.17 / $1,758.37
| Professional | | $729.69 | $1,177.17 | $1,758.37 |