- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.60 / $3,357.54 / $5,839.20
| Facility | | $2,919.60 | $3,357.54 | $5,839.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.29 / $3,357.54 / $3,357.54
| Professional | | $2,277.29 | $3,357.54 | $3,357.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.69 / $515.80 / $1,894.38
| Professional | | $424.69 | $515.80 | $1,894.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.79 / $2,372.17 / $6,319.47
| Facility | | $1,859.79 | $2,372.17 | $6,319.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,335.67 / $2,335.67 / $2,335.67
| Professional | | $2,335.67 | $2,335.67 | $2,335.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,627.64 / $2,627.64 / $2,919.60
| Facility | | $2,627.64 | $2,627.64 | $2,919.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,226.23 / $2,919.60
| Professional | | $1,226.23 | $1,226.23 | $2,919.60 |