- 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
- $561.67 / $729.29 / $910.63
| Professional | | $561.67 | $729.29 | $910.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.16 / $743.48 / $1,104.57
| Professional | | $537.16 | $743.48 | $1,104.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.46 / $914.98 / $1,257.41
| Professional | | $774.46 | $914.98 | $1,257.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.00 / $6,315.00 / $12,945.00
| Facility | | $3,007.00 | $6,315.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.57 / $861.48 / $1,253.00
| Professional | | $543.57 | $861.48 | $1,253.00 |