- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.35 / $4,183.13 / $10,039.50
| Facility | | $3,137.35 | $4,183.13 | $10,039.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,095.52 / $3,095.52 / $4,475.95
| Professional | | $3,095.52 | $3,095.52 | $4,475.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.03 / $2,719.03 / $3,670.69
| Facility | | $2,719.03 | $2,719.03 | $3,670.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,095.32 / $5,095.32 / $6,104.77
| Professional | | $5,095.32 | $5,095.32 | $6,104.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,095.52 / $3,944.59 / $6,902.16
| Facility | | $3,095.52 | $3,944.59 | $6,902.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.91 / $1,756.91 / $5,521.73
| Professional | | $1,756.91 | $1,756.91 | $5,521.73 |
- 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 |