- 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
- $831.77 / $1,513.39 / $1,587.76
| Professional | | $831.77 | $1,513.39 | $1,587.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.12 / $1,664.85 / $2,637.28
| Professional | | $1,415.12 | $1,664.85 | $2,637.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.31 / $1,838.36 / $2,940.04
| Professional | | $1,298.31 | $1,838.36 | $2,940.04 |
- 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
- $1,339.65 / $1,832.34 / $2,872.53
| Professional | | $1,339.65 | $1,832.34 | $2,872.53 |