- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,583.64 / $3,583.64 / $3,794.51
| Facility | | $3,583.64 | $3,583.64 | $3,794.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,869.97 / $3,380.35 / $4,490.32
| Professional | | $2,869.97 | $3,380.35 | $4,490.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,649.81 / $3,649.81 / $3,649.81
| Facility | | $3,649.81 | $3,649.81 | $3,649.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,531.71 / $4,138.68 / $4,316.60
| Professional | | $3,531.71 | $4,138.68 | $4,316.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,282.89 / $3,282.89 / $3,282.89
| Facility | | $3,282.89 | $3,282.89 | $3,282.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.23 / $3,282.89 / $4,990.77
| Professional | | $498.23 | $3,282.89 | $4,990.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,222.73 / $2,881.68 / $4,766.60
| Professional | | $2,222.73 | $2,881.68 | $4,766.60 |