- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,091.27 / $3,926.57 / $6,067.34
| Facility | | $2,091.27 | $3,926.57 | $6,067.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.15 / $1,653.18 / $2,033.22
| Professional | | $1,425.15 | $1,653.18 | $2,033.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,375.25 / $2,375.25 / $2,375.25
| Professional | | $2,375.25 | $2,375.25 | $2,375.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.78 / $3,112.53 / $3,847.43
| Facility | | $1,679.78 | $3,112.53 | $3,847.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,558.17 / $1,900.20 / $2,556.37
| Facility | | $1,558.17 | $1,900.20 | $2,556.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $1,140.11 / $9,463.00
| Professional | | $798.08 | $1,140.11 | $9,463.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $1,140.11 / $3,040.32
| Professional | | $798.08 | $1,140.11 | $3,040.32 |