- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,918.31 / $7,585.78
| Facility | | $3,715.35 | $6,918.31 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,019.95 / $6,918.31
| Professional | | $2,818.38 | $3,019.95 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,570.40 / $3,162.28
| Facility | | $2,454.71 | $2,570.40 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,698.24 / $4,466.84
| Professional | | $1,621.81 | $1,698.24 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,388.44 / $3,715.35
| Facility | | $2,630.27 | $3,388.44 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,862.09 / $6,456.54
| Professional | | $1,445.44 | $1,862.09 | $6,456.54 |