- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $3,981.07 / $8,511.38
| Facility | | $3,801.89 | $3,981.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,801.89 / $5,754.40
| Professional | | $3,548.13 | $3,801.89 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,912.51 / $10,715.19
| Professional | | $7,413.10 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,413.10 / $12,882.50
| Professional | | $5,370.32 | $7,413.10 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,888.44 / $12,022.64
| Facility | | $3,981.07 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,165.95 / $8,709.64
| Professional | | $3,388.44 | $6,165.95 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,309.57 / $9,549.93
| Professional | | $3,388.44 | $6,309.57 | $9,549.93 |