- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.10 / $1,319.79 / $1,426.82
| Professional | | $798.10 | $1,319.79 | $1,426.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,282.51 / $12,211.56
| Facility | | $8,912.51 | $10,282.51 | $12,211.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,356.76 / $1,998.66 / $3,079.44
| Professional | | $1,356.76 | $1,998.66 | $3,079.44 |