- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $4,937.68
| Facility | | $3,706.14 | $3,955.04 | $4,937.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.04 / $998.50 / $1,336.76
| Professional | | $977.04 | $998.50 | $1,336.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.51 / $1,192.35 / $1,902.60
| Professional | | $1,013.51 | $1,192.35 | $1,902.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $1,334.51 / $2,019.33
| Professional | | $300.00 | $1,334.51 | $2,019.33 |
- 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
- $885.79 / $1,389.80 / $2,138.17
| Professional | | $885.79 | $1,389.80 | $2,138.17 |