- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $6,760.83
| Facility | | $1,122.02 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $2,041.74
| Professional | | $630.96 | $912.01 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,778.28 / $17,782.79
| Facility | | $794.33 | $1,778.28 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $1,905.46
| Professional | | $1,148.15 | $1,621.81 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $19,498.45
| Facility | | $8,511.38 | $11,748.98 | $19,498.45 |