- 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
- $1,011.37 / $1,349.32 / $1,880.08
| Professional | | $1,011.37 | $1,349.32 | $1,880.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.16 / $1,389.84 / $2,458.23
| Professional | | $1,004.16 | $1,389.84 | $2,458.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.84 / $1,778.17 / $2,317.73
| Professional | | $1,389.84 | $1,778.17 | $2,317.73 |
- 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
- $998.72 / $1,560.50 / $2,483.27
| Professional | | $998.72 | $1,560.50 | $2,483.27 |