- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.50 / $2,080.50 / $2,191.46
| Facility | | $2,080.50 | $2,080.50 | $2,191.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,692.14 / $2,190.16 / $2,706.40
| Professional | | $1,692.14 | $2,190.16 | $2,706.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,405.86 / $3,809.06 / $5,078.75
| Professional | | $3,405.86 | $3,809.06 | $5,078.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,576.44 / $2,576.44 / $2,576.44
| Facility | | $2,576.44 | $2,576.44 | $2,576.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $1,472.88 / $2,910.00
| Professional | | $192.51 | $1,472.88 | $2,910.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,442.39 / $9,481.87 / $9,827.61
| Facility | | $3,442.39 | $9,481.87 | $9,827.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.50 / $283.08 / $2,475.60
| Professional | | $110.50 | $283.08 | $2,475.60 |