- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.69 / $2,109.33 / $2,486.16
| Professional | | $1,487.69 | $2,109.33 | $2,486.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.59 / $1,964.84 / $3,178.52
| Professional | | $1,419.59 | $1,964.84 | $3,178.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.71 / $2,657.19 / $3,411.47
| Professional | | $2,046.71 | $2,657.19 | $3,411.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.00 / $6,315.00 / $12,945.00
| Facility | | $3,007.00 | $6,315.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.12 / $2,364.71 / $3,605.66
| Professional | | $1,470.12 | $2,364.71 | $3,605.66 |