- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,918.45 / $3,918.45 / $31,974.60
| Facility | | $3,918.45 | $3,918.45 | $31,974.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,918.45 / $3,918.45 / $4,075.19
| Professional | | $3,918.45 | $3,918.45 | $4,075.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,179.68 / $4,806.63 / $4,806.63
| Professional | | $4,179.68 | $4,806.63 | $4,806.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,489.98 / $8,829.57 / $18,993.40
| Facility | | $8,489.98 | $8,829.57 | $18,993.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,063.82 / $6,063.82 / $6,664.20
| Professional | | $6,063.82 | $6,063.82 | $6,664.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,008.29 / $10,620.04 / $10,620.04
| Professional | | $6,008.29 | $10,620.04 | $10,620.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,269.52 / $6,269.52 / $6,269.52
| Facility | | $6,269.52 | $6,269.52 | $6,269.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $8,307.11
| Professional | | $2,194.33 | $3,134.76 | $8,307.11 |