- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,370.32 / $7,943.28
| Facility | | $1,071.52 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,000.00 / $2,818.38
| Professional | | $645.65 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,584.89 / $9,772.37
| Facility | | $933.25 | $1,584.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,659.59 / $1,862.09
| Professional | | $1,479.11 | $1,659.59 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,120.11 / $14,125.38
| Facility | | $5,128.61 | $9,120.11 | $14,125.38 |