- 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
- $776.46 / $1,088.13 / $1,268.70
| Professional | | $776.46 | $1,088.13 | $1,268.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $739.08 / $1,022.95 / $1,617.19
| Professional | | $739.08 | $1,022.95 | $1,617.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.58 / $1,388.24 / $1,750.96
| Professional | | $1,065.58 | $1,388.24 | $1,750.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,713.00 / $7,457.00 / $12,945.00
| Facility | | $3,713.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.55 / $1,213.70 / $1,834.50
| Professional | | $773.55 | $1,213.70 | $1,834.50 |