- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.88 / $4,004.70 / $6,188.07
| Facility | | $2,132.88 | $4,004.70 | $6,188.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.51 / $1,686.07 / $2,073.67
| Professional | | $1,453.51 | $1,686.07 | $2,073.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,422.51 / $2,422.51 / $2,422.51
| Professional | | $2,422.51 | $2,422.51 | $2,422.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.21 / $3,174.47 / $4,394.43
| Facility | | $1,713.21 | $3,174.47 | $4,394.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.41 / $1,938.01 / $2,607.23
| Facility | | $1,550.41 | $1,938.01 | $2,607.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $1,162.81 / $9,651.29
| Professional | | $813.96 | $1,162.81 | $9,651.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.96 / $1,162.81 / $4,032.61
| Professional | | $813.96 | $1,162.81 | $4,032.61 |