- 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
- $1,857.48 / $2,512.21 / $3,094.42
| Professional | | $1,857.48 | $2,512.21 | $3,094.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,758.45 / $2,433.85 / $3,980.48
| Professional | | $1,758.45 | $2,433.85 | $3,980.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,411.70 / $3,067.84 / $4,264.97
| Professional | | $1,411.70 | $3,067.84 | $4,264.97 |
- 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
- $1,030.71 / $2,884.96 / $4,515.38
| Professional | | $1,030.71 | $2,884.96 | $4,515.38 |