- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,521.17 / $4,474.39 / $10,360.68
| Facility | | $3,521.17 | $4,474.39 | $10,360.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,643.84 / $2,643.84 / $2,839.79
| Professional | | $2,643.84 | $2,643.84 | $2,839.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,517.36 / $2,643.84 / $2,643.84
| Facility | | $2,517.36 | $2,643.84 | $2,643.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,643.84 / $2,643.84 / $3,761.23
| Professional | | $2,643.84 | $2,643.84 | $3,761.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,127.26 / $4,127.26 / $4,891.22
| Facility | | $4,127.26 | $4,127.26 | $4,891.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,592.00 / $2,592.00 / $3,753.99
| Professional | | $2,592.00 | $2,592.00 | $3,753.99 |