- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,094.19 / $16,213.60 / $21,257.10
| Facility | | $3,094.19 | $16,213.60 | $21,257.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,094.19 / $3,094.19 / $3,094.19
| Professional | | $3,094.19 | $3,094.19 | $3,094.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,938.62 / $3,022.37 / $9,472.85
| Facility | | $2,938.62 | $3,022.37 | $9,472.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,125.58 / $4,125.58 / $4,125.58
| Professional | | $4,125.58 | $4,125.58 | $4,125.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,541.12 / $3,953.68 / $3,953.68
| Facility | | $3,541.12 | $3,953.68 | $3,953.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,560.06 / $3,955.62 / $5,138.18
| Professional | | $3,560.06 | $3,955.62 | $5,138.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.95 / $1,443.95 / $2,062.79
| Professional | | $1,443.95 | $1,443.95 | $2,062.79 |