- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $2,914.90 / $4,882.52
| Facility | | $1,277.00 | $2,914.90 | $4,882.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,439.39 / $3,060.49 / $3,641.98
| Professional | | $2,439.39 | $3,060.49 | $3,641.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,916.95 / $3,646.19 / $3,860.67
| Professional | | $2,916.95 | $3,646.19 | $3,860.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,855.12 / $4,195.21 / $5,123.09
| Professional | | $2,855.12 | $4,195.21 | $5,123.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,896.00 / $5,455.00 / $12,000.00
| Facility | | $2,896.00 | $5,455.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,418.08 / $3,273.66 / $5,188.97
| Professional | | $2,418.08 | $3,273.66 | $5,188.97 |