- 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
- $1,047.33 / $1,680.15 / $2,017.63
| Professional | | $1,047.33 | $1,680.15 | $2,017.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.38 / $1,751.03 / $3,127.30
| Professional | | $1,488.38 | $1,751.03 | $3,127.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,385.94 / $2,032.70 / $3,417.31
| Professional | | $1,385.94 | $2,032.70 | $3,417.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $4,915.00 / $7,205.00
| Facility | | $1,649.00 | $4,915.00 | $7,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.37 / $2,059.73 / $3,026.01
| Professional | | $1,716.37 | $2,059.73 | $3,026.01 |