- 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
- $706.85 / $1,343.62 / $1,502.50
| Professional | | $706.85 | $1,343.62 | $1,502.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,176.10 / $1,383.66 / $2,119.88
| Professional | | $1,176.10 | $1,383.66 | $2,119.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.55 / $1,198.08 / $2,446.69
| Professional | | $878.55 | $1,198.08 | $2,446.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.50 / $1,541.05 / $3,178.21
| Professional | | $719.50 | $1,541.05 | $3,178.21 |