- 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
- $1,207.86 / $1,687.52 / $2,044.40
| Professional | | $1,207.86 | $1,687.52 | $2,044.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.73 / $1,606.55 / $2,800.00
| Professional | | $1,160.73 | $1,606.55 | $2,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.56 / $2,226.98 / $2,760.03
| Professional | | $1,656.56 | $2,226.98 | $2,760.03 |
- 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
- $1,097.42 / $1,640.86 / $2,576.51
| Professional | | $1,097.42 | $1,640.86 | $2,576.51 |