- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,706.14 / $3,955.04
| Facility | | $3,706.14 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.81 / $1,200.66 / $1,330.38
| Professional | | $742.81 | $1,200.66 | $1,330.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.05 / $1,237.71 / $2,038.81
| Professional | | $1,052.05 | $1,237.71 | $2,038.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.34 / $1,431.94 / $2,387.05
| Professional | | $992.34 | $1,431.94 | $2,387.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.15 / $1,377.74 / $2,134.02
| Professional | | $1,010.15 | $1,377.74 | $2,134.02 |