- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,948.68 / $1,948.68 / $2,063.37
| Facility | | $1,948.68 | $1,948.68 | $2,063.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,562.88 / $1,838.15 / $2,306.79
| Professional | | $1,562.88 | $1,838.15 | $2,306.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,145.80 / $4,724.94 / $4,724.94
| Facility | | $3,145.80 | $4,724.94 | $4,724.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,020.26 / $2,268.25 / $2,354.15
| Professional | | $2,020.26 | $2,268.25 | $2,354.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.09 / $1,850.09 / $1,850.09
| Facility | | $1,850.09 | $1,850.09 | $1,850.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,572.58 / $1,572.58 / $3,648.75
| Professional | | $1,572.58 | $1,572.58 | $3,648.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.87 / $1,873.91 / $2,990.40
| Professional | | $1,373.87 | $1,873.91 | $2,990.40 |