- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,861.72 / $5,026.67 / $7,356.11
| Facility | | $2,861.72 | $5,026.67 | $7,356.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,026.67 / $7,356.11 / $8,275.62
| Professional | | $5,026.67 | $7,356.11 | $8,275.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,264.62 / $4,264.62 / $4,691.07
| Facility | | $4,264.62 | $4,264.62 | $4,691.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,826.32 / $5,826.32 / $5,826.32
| Professional | | $5,826.32 | $5,826.32 | $5,826.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,210.58 / $5,210.58 / $5,256.95
| Facility | | $5,210.58 | $5,210.58 | $5,256.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,210.58 / $5,210.58 / $5,210.58
| Professional | | $5,210.58 | $5,210.58 | $5,210.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,867.32 / $2,074.81 / $7,297.72
| Professional | | $1,867.32 | $2,074.81 | $7,297.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,904.07 / $5,108.41 / $6,640.93
| Professional | | $4,904.07 | $5,108.41 | $6,640.93 |