- 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
- $1,451.46 / $2,001.56 / $2,451.91
| Professional | | $1,451.46 | $2,001.56 | $2,451.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.74 / $1,879.22 / $3,040.79
| Professional | | $1,357.74 | $1,879.22 | $3,040.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,957.52 / $2,617.51 / $3,343.11
| Professional | | $1,957.52 | $2,617.51 | $3,343.11 |
- 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
- $1,439.23 / $2,294.62 / $3,449.42
| Professional | | $1,439.23 | $2,294.62 | $3,449.42 |