- 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
- $2,573.67 / $3,642.43 / $4,323.74
| Professional | | $2,573.67 | $3,642.43 | $4,323.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,436.58 / $3,372.42 / $5,506.60
| Professional | | $2,436.58 | $3,372.42 | $5,506.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,512.94 / $4,551.39 / $5,907.86
| Professional | | $3,512.94 | $4,551.39 | $5,907.86 |
- 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
- $2,543.55 / $3,684.73 / $6,246.60
| Professional | | $2,543.55 | $3,684.73 | $6,246.60 |