- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.68 / $1,758.07 / $2,312.13
| Professional | | $1,201.68 | $1,758.07 | $2,312.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.53 / $1,700.39 / $2,873.62
| Professional | | $1,228.53 | $1,700.39 | $2,873.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.39 / $2,089.23 / $2,845.29
| Professional | | $1,700.39 | $2,089.23 | $2,845.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,219.00 / $7,228.00 / $12,680.00
| Facility | | $3,219.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.50 / $1,914.85 / $3,047.78
| Professional | | $1,225.50 | $1,914.85 | $3,047.78 |