- 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
- $1,051.61 / $1,135.33 / $1,295.96
| Professional | | $1,051.61 | $1,135.33 | $1,295.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,276.01 / $1,766.11 / $2,056.29
| Professional | | $1,276.01 | $1,766.11 | $2,056.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.77 / $1,830.12 / $2,268.00
| Professional | | $1,329.77 | $1,830.12 | $2,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $3,539.00 / $6,383.00
| Facility | | $1,649.00 | $3,539.00 | $6,383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.42 / $1,414.56 / $2,197.25
| Professional | | $976.42 | $1,414.56 | $2,197.25 |