- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.11 / $1,260.41 / $1,725.71
| Professional | | $949.11 | $1,260.41 | $1,725.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.92 / $1,303.69 / $2,301.42
| Professional | | $941.92 | $1,303.69 | $2,301.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.69 / $1,661.11 / $2,172.09
| Professional | | $1,303.69 | $1,661.11 | $2,172.09 |
- 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
- $958.27 / $1,505.62 / $2,327.42
| Professional | | $958.27 | $1,505.62 | $2,327.42 |