- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,292.05 / $5,588.74 / $11,803.40
| Facility | | $3,292.05 | $5,588.74 | $11,803.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $3,175.86 / $3,679.35
| Professional | | $2,711.10 | $3,175.86 | $3,679.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,583.88 / $4,182.84 / $11,709.24
| Facility | | $3,583.88 | $4,182.84 | $11,709.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $1,626.66 / $4,076.33
| Professional | | $573.20 | $1,626.66 | $4,076.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.48 / $6,545.37 / $11,253.00
| Facility | | $3,675.48 | $6,545.37 | $11,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $4,717.52 / $5,652.12
| Professional | | $3,873.00 | $4,717.52 | $5,652.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,485.70 / $3,485.70 / $3,485.70
| Facility | | $3,485.70 | $3,485.70 | $3,485.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $4,647.60
| Professional | | $1,626.66 | $2,323.80 | $4,647.60 |