- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,184.41 / $4,970.04 / $11,956.11
| Facility | | $3,184.41 | $4,970.04 | $11,956.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,749.35 / $4,671.47 / $6,676.40
| Professional | | $2,749.35 | $4,671.47 | $6,676.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,759.58 / $4,535.49 / $9,414.26
| Facility | | $2,759.58 | $4,535.49 | $9,414.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,490.36 / $4,099.00 / $5,647.73
| Professional | | $2,490.36 | $4,099.00 | $5,647.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,782.67 / $2,782.67 / $2,782.67
| Facility | | $2,782.67 | $2,782.67 | $2,782.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,001.20 / $11,001.20 / $11,001.20
| Professional | | $11,001.20 | $11,001.20 | $11,001.20 |