- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.41 / $2,336.03 / $3,993.10
| Facility | | $1,600.41 | $2,336.03 | $3,993.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,880.00 / $2,189.69 / $3,160.17
| Professional | | $1,880.00 | $2,189.69 | $3,160.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.67 / $2,627.64 / $2,995.51
| Professional | | $2,335.67 | $2,627.64 | $2,995.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.88 / $1,918.93 / $3,778.14
| Facility | | $1,450.88 | $1,918.93 | $3,778.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.39 / $2,075.64 / $7,175.64
| Professional | | $1,547.39 | $2,075.64 | $7,175.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $3,503.52 / $4,379.39
| Professional | | $2,919.60 | $3,503.52 | $4,379.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,372.21 / $2,334.34
| Professional | | $1,226.23 | $1,372.21 | $2,334.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.64 / $1,459.80 / $2,321.08
| Professional | | $1,138.64 | $1,459.80 | $2,321.08 |