- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $1,000.00
| Professional | | $446.68 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $3,235.94
| Facility | | $2,041.74 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $776.25
| Professional | | $436.52 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $1,202.26
| Professional | | $426.58 | $588.84 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,467.37 / $5,011.87
| Facility | | $954.99 | $3,467.37 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $831.76
| Professional | | $380.19 | $524.81 | $831.76 |