- 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
- $1,517.87 / $2,075.44 / $2,907.17
| Professional | | $1,517.87 | $2,075.44 | $2,907.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,541.16 / $2,133.09 / $3,652.68
| Professional | | $1,541.16 | $2,133.09 | $3,652.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.08 / $2,726.02 / $3,547.69
| Professional | | $2,133.08 | $2,726.02 | $3,547.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $2,257.00 / $6,383.00
| Facility | | $1,649.00 | $2,257.00 | $6,383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.97 / $2,459.14 / $4,065.02
| Professional | | $1,488.97 | $2,459.14 | $4,065.02 |