- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,792.35 / $3,961.94 / $9,530.98
| Facility | | $2,792.35 | $3,961.94 | $9,530.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,147.12 / $3,412.20 / $4,909.35
| Professional | | $2,147.12 | $3,412.20 | $4,909.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.50 / $3,622.16 / $7,504.71
| Facility | | $2,538.50 | $3,622.16 | $7,504.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.75 / $2,978.75 / $4,502.16
| Professional | | $1,878.75 | $2,978.75 | $4,502.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.34 / $2,767.34 / $3,052.73
| Facility | | $2,767.34 | $2,767.34 | $3,052.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,122.00 / $14,660.15 / $14,660.15
| Professional | | $2,122.00 | $14,660.15 | $14,660.15 |