- 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
- $191.00 / $446.52 / $1,400.15
| Professional | | $191.00 | $446.52 | $1,400.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.62 / $597.53 / $1,914.03
| Professional | | $403.62 | $597.53 | $1,914.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.96 / $788.30 / $2,789.55
| Professional | | $225.96 | $788.30 | $2,789.55 |
- 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
- $1,133.94 / $1,578.60 / $2,753.26
| Professional | | $1,133.94 | $1,578.60 | $2,753.26 |