- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $5,496.04
| Facility | | $3,706.14 | $3,955.04 | $5,496.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.50 / $937.24 / $1,281.14
| Professional | | $804.50 | $937.24 | $1,281.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.58 / $1,134.80 / $1,836.92
| Professional | | $964.58 | $1,134.80 | $1,836.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $1,331.37 / $1,922.76
| Professional | | $300.00 | $1,331.37 | $1,922.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $896.03 / $1,123.11 / $1,920.83
| Professional | | $896.03 | $1,123.11 | $1,920.83 |