- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $5,496.04
| Facility | | $3,706.14 | $3,955.04 | $5,496.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.28 / $1,599.72 / $1,678.85
| Professional | | $1,417.28 | $1,599.72 | $1,678.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.71 / $1,785.54 / $2,720.21
| Professional | | $1,517.71 | $1,785.54 | $2,720.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.28 / $1,799.64 / $3,202.49
| Professional | | $1,215.28 | $1,799.64 | $3,202.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.30 / $1,500.48 / $2,218.31
| Professional | | $1,071.30 | $1,500.48 | $2,218.31 |