- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,706.14 / $3,955.04
| Facility | | $3,706.14 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.63 / $1,481.22 / $1,505.15
| Professional | | $901.63 | $1,481.22 | $1,505.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.62 / $1,394.64 / $1,992.36
| Professional | | $1,007.62 | $1,394.64 | $1,992.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.75 / $2,085.02 / $2,416.63
| Professional | | $1,452.75 | $2,085.02 | $2,416.63 |
- 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
- $1,065.92 / $1,675.13 / $2,260.11
| Professional | | $1,065.92 | $1,675.13 | $2,260.11 |