- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,770.77 / $3,762.41 / $8,749.79
| Facility | | $2,770.77 | $3,762.41 | $8,749.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,916.60 / $2,916.60 / $2,916.60
| Professional | | $2,916.60 | $2,916.60 | $2,916.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.14 / $4,280.10 / $7,218.59
| Facility | | $1,263.14 | $4,280.10 | $7,218.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.33 / $1,749.96 / $3,771.45
| Professional | | $1,264.33 | $1,749.96 | $3,771.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.52 / $3,644.85 / $13,269.03
| Facility | | $2,919.52 | $3,644.85 | $13,269.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,354.09 / $5,314.05 / $7,204.00
| Professional | | $3,354.09 | $5,314.05 | $7,204.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,341.64 / $1,749.96 / $5,118.34
| Professional | | $1,341.64 | $1,749.96 | $5,118.34 |