- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,133.15 / $4,669.96 / $5,546.58
| Facility | | $3,133.15 | $4,669.96 | $5,546.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,709.68 / $1,986.16 / $2,149.79
| Professional | | $1,709.68 | $1,986.16 | $2,149.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,702.53 / $4,245.42 / $5,915.15
| Facility | | $2,702.53 | $4,245.42 | $5,915.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,692.75 / $1,692.75 / $1,805.60
| Professional | | $1,692.75 | $1,692.75 | $1,805.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.26 / $1,620.26 / $1,620.26
| Facility | | $1,620.26 | $1,620.26 | $1,620.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,445.49 / $8,445.49 / $8,445.49
| Professional | | $8,445.49 | $8,445.49 | $8,445.49 |