- 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
- $785.20 / $893.55 / $1,006.37
| Professional | | $785.20 | $893.55 | $1,006.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.44 / $1,061.69 / $1,523.12
| Professional | | $902.44 | $1,061.69 | $1,523.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.51 / $1,086.67 / $1,940.43
| Professional | | $703.51 | $1,086.67 | $1,940.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.29 / $847.39 / $1,248.79
| Professional | | $579.29 | $847.39 | $1,248.79 |