- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.73 / $815.85 / $1,092.76
| Professional | | $798.73 | $815.85 | $1,092.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.94 / $981.11 / $1,549.58
| Professional | | $833.94 | $981.11 | $1,549.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $1,069.85 / $1,639.51
| Professional | | $150.00 | $1,069.85 | $1,639.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,074.00 / $7,819.00 / $19,195.00
| Facility | | $5,074.00 | $7,819.00 | $19,195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.72 / $1,135.51 / $1,747.73
| Professional | | $723.72 | $1,135.51 | $1,747.73 |