- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,183.13 / $4,810.60 / $8,366.26
| Facility | | $4,183.13 | $4,810.60 | $8,366.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,262.85 / $4,810.60 / $4,810.60
| Professional | | $3,262.85 | $4,810.60 | $4,810.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.80 / $451.58 / $2,714.22
| Professional | | $371.80 | $451.58 | $2,714.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,290.03 / $3,534.74 / $13,118.68
| Facility | | $3,290.03 | $3,534.74 | $13,118.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.91 / $1,756.91 / $4,183.13
| Professional | | $1,756.91 | $1,756.91 | $4,183.13 |