- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.47 / $15,834.63 / $15,834.63
| Facility | | $1,115.47 | $15,834.63 | $15,834.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.79 / $1,115.47 / $1,841.29
| Professional | | $998.79 | $1,115.47 | $1,841.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,152.69 / $2,360.39 / $2,829.59
| Professional | | $2,152.69 | $2,360.39 | $2,829.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,366.81 / $2,563.35 / $3,310.20
| Professional | | $1,366.81 | $2,563.35 | $3,310.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.47 / $1,545.44 / $3,346.41
| Facility | | $1,115.47 | $1,545.44 | $3,346.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.27 / $2,076.23 / $2,880.92
| Professional | | $1,216.27 | $2,076.23 | $2,880.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.27 / $2,211.40 / $2,919.32
| Professional | | $1,216.27 | $2,211.40 | $2,919.32 |