- 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
- $1,017.66 / $1,916.32 / $1,976.55
| Professional | | $1,017.66 | $1,916.32 | $1,976.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.40 / $2,012.24 / $3,015.26
| Professional | | $1,710.40 | $2,012.24 | $3,015.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,566.78 / $2,236.17 / $3,548.88
| Professional | | $1,566.78 | $2,236.17 | $3,548.88 |
- 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
- $1,706.83 / $2,209.96 / $3,467.41
| Professional | | $1,706.83 | $2,209.96 | $3,467.41 |