- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,032.46 / $2,032.46 / $16,584.90
| Facility | | $2,032.46 | $2,032.46 | $16,584.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.46 / $2,032.46 / $2,113.76
| Professional | | $2,032.46 | $2,032.46 | $2,113.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.96 / $2,493.15 / $2,493.15
| Professional | | $2,167.96 | $2,493.15 | $2,493.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,403.68 / $4,579.82 / $9,851.43
| Facility | | $4,403.68 | $4,579.82 | $9,851.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,145.16 / $3,145.16 / $3,456.56
| Professional | | $3,145.16 | $3,145.16 | $3,456.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,116.44 / $5,508.52 / $5,508.52
| Professional | | $3,116.44 | $5,508.52 | $5,508.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.18 / $1,625.97 / $3,387.44
| Professional | | $1,138.18 | $1,625.97 | $3,387.44 |