- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $7,887.60
| Facility | | $2,424.15 | $3,706.14 | $7,887.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.03 / $416.62 / $3,315.24
| Professional | | $159.03 | $416.62 | $3,315.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.14 / $483.50 / $4,390.03
| Professional | | $285.14 | $483.50 | $4,390.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.03 / $505.46 / $4,946.47
| Professional | | $207.03 | $505.46 | $4,946.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,596.00 / $7,457.00 / $12,945.00
| Facility | | $4,596.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,932.72 / $3,442.48 / $5,338.43
| Professional | | $1,932.72 | $3,442.48 | $5,338.43 |