- 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
- $1,541.67 / $2,144.28 / $2,518.35
| Professional | | $1,541.67 | $2,144.28 | $2,518.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,464.58 / $2,027.10 / $2,925.55
| Professional | | $1,464.58 | $2,027.10 | $2,925.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,111.56 / $2,637.64 / $3,543.71
| Professional | | $2,111.56 | $2,637.64 | $3,543.71 |
- 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
- $1,487.29 / $2,456.37 / $3,489.08
| Professional | | $1,487.29 | $2,456.37 | $3,489.08 |