- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,454.71
| Facility | | $1,047.13 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,047.13
| Professional | | $724.44 | $891.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,466.84
| Facility | | $3,235.94 | $3,235.94 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,047.13
| Professional | | $794.33 | $794.33 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,174.90 / $1,445.44
| Professional | | $575.44 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $7,079.46
| Facility | | $977.24 | $2,137.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $812.83 / $1,479.11
| Professional | | $676.08 | $812.83 | $1,479.11 |