- 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
- $1,145.70 / $1,169.57 / $1,565.86
| Professional | | $1,145.70 | $1,169.57 | $1,565.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.11 / $1,400.14 / $2,226.77
| Professional | | $1,190.11 | $1,400.14 | $2,226.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $1,522.57 / $2,360.01
| Professional | | $350.00 | $1,522.57 | $2,360.01 |
- 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
- $1,096.85 / $1,426.15 / $2,234.40
| Professional | | $1,096.85 | $1,426.15 | $2,234.40 |