- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,706.14 / $3,955.04 / $4,937.68
| Facility | | $3,706.14 | $3,955.04 | $4,937.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.91 / $2,664.56 / $3,085.47
| Professional | | $1,872.91 | $2,664.56 | $3,085.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,934.01 / $2,676.84 / $3,944.03
| Professional | | $1,934.01 | $2,676.84 | $3,944.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,336.46 / $3,310.09 / $4,644.26
| Professional | | $2,336.46 | $3,310.09 | $4,644.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,713.00 / $7,457.00 / $12,945.00
| Facility | | $3,713.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.76 / $3,188.29 / $4,937.07
| Professional | | $1,755.76 | $3,188.29 | $4,937.07 |