- 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
- $977.07 / $1,149.81 / $1,177.23
| Professional | | $977.07 | $1,149.81 | $1,177.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.63 / $1,254.85 / $1,957.22
| Professional | | $1,066.63 | $1,254.85 | $1,957.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.04 / $1,259.69 / $2,247.46
| Professional | | $831.04 | $1,259.69 | $2,247.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.60 / $1,018.66 / $1,528.21
| Professional | | $699.60 | $1,018.66 | $1,528.21 |