- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.56 / $3,850.16 / $5,949.26
| Facility | | $2,050.56 | $3,850.16 | $5,949.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.42 / $1,621.00 / $1,993.65
| Professional | | $1,397.42 | $1,621.00 | $1,993.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,329.03 / $2,329.03 / $2,329.03
| Professional | | $2,329.03 | $2,329.03 | $2,329.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,647.08 / $3,051.95 / $3,772.55
| Facility | | $1,647.08 | $3,051.95 | $3,772.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.84 / $1,863.22 / $2,506.62
| Facility | | $1,527.84 | $1,863.22 | $2,506.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $1,117.93 / $9,278.84
| Professional | | $782.55 | $1,117.93 | $9,278.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.55 / $1,117.93 / $2,794.83
| Professional | | $782.55 | $1,117.93 | $2,794.83 |