- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.65 / $6,206.43 / $10,427.28
| Facility | | $1,908.65 | $6,206.43 | $10,427.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,859.17 / $4,560.00 / $8,775.00
| Professional | | $3,859.17 | $4,560.00 | $8,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.50 / $1,326.50 / $1,326.50
| Professional | | $1,326.50 | $1,326.50 | $1,326.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.67 / $3,859.17 / $7,525.38
| Facility | | $2,153.67 | $3,859.17 | $7,525.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,983.66 / $3,983.66 / $3,983.66
| Professional | | $3,983.66 | $3,983.66 | $3,983.66 |