- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.11 / $1,151.08 / $1,204.88
| Professional | | $1,056.11 | $1,151.08 | $1,204.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,089.55 / $1,281.82 / $1,984.77
| Professional | | $1,089.55 | $1,281.82 | $1,984.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.78 / $1,284.13 / $2,282.42
| Professional | | $866.78 | $1,284.13 | $2,282.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,599.00 / $8,699.00 / $12,680.00
| Facility | | $3,599.00 | $8,699.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.66 / $1,084.06 / $1,649.33
| Professional | | $766.66 | $1,084.06 | $1,649.33 |