- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,863.69 / $3,184.93 / $3,453.85
| Professional | | $1,863.69 | $3,184.93 | $3,453.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,296.52 / $3,178.58 / $4,206.20
| Professional | | $2,296.52 | $3,178.58 | $4,206.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.02 / $4,241.35 / $5,501.32
| Professional | | $3,311.02 | $4,241.35 | $5,501.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,219.00 / $7,228.00 / $12,680.00
| Facility | | $3,219.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,283.28 / $3,387.03 / $5,431.18
| Professional | | $2,283.28 | $3,387.03 | $5,431.18 |