- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,888.44 / $8,511.38
| Facility | | $4,466.84 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,174.90 / $2,344.23
| Professional | | $562.34 | $1,174.90 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,951.21 / $7,943.28
| Facility | | $2,398.83 | $2,951.21 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $2,454.71
| Professional | | $776.25 | $776.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $912.01 / $1,445.44
| Professional | | $524.81 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $2,691.53
| Professional | | $660.69 | $912.01 | $2,691.53 |