- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,915.06 / $6,567.00 / $15,797.82
| Facility | | $3,915.06 | $6,567.00 | $15,797.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.38 / $2,883.76 / $4,000.95
| Professional | | $2,293.38 | $2,883.76 | $4,000.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,589.09 / $6,003.82 / $12,439.23
| Facility | | $3,589.09 | $6,003.82 | $12,439.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,270.67 / $2,270.67 / $3,589.09
| Professional | | $2,270.67 | $2,270.67 | $3,589.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,083.49 / $5,083.49 / $5,083.49
| Facility | | $5,083.49 | $5,083.49 | $5,083.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,385.44 / $8,385.44 / $8,385.44
| Professional | | $8,385.44 | $8,385.44 | $8,385.44 |