- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.76 / $1,294.15 / $1,509.70
| Professional | | $919.76 | $1,294.15 | $1,509.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.24 / $1,212.79 / $2,031.82
| Professional | | $876.24 | $1,212.79 | $2,031.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.32 / $1,643.08 / $2,141.03
| Professional | | $1,263.32 | $1,643.08 | $2,141.03 |
- 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
- $918.74 / $1,484.09 / $2,288.57
| Professional | | $918.74 | $1,484.09 | $2,288.57 |