- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.94 / $3,877.94 / $9,956.87
| Facility | | $3,877.94 | $3,877.94 | $9,956.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,877.94 / $5,386.28 / $9,956.87
| Professional | | $3,877.94 | $5,386.28 | $9,956.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,969.51 / $11,969.51 / $11,969.51
| Facility | | $11,969.51 | $11,969.51 | $11,969.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,312.49 / $7,312.49 / $15,959.35
| Professional | | $7,312.49 | $7,312.49 | $15,959.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,121.18 / $8,121.18 / $8,811.67
| Facility | | $8,121.18 | $8,121.18 | $8,811.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,928.46 / $5,928.46 / $8,121.18
| Professional | | $5,928.46 | $5,928.46 | $8,121.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,656.11 / $9,575.61 / $15,560.36
| Professional | | $6,656.11 | $9,575.61 | $15,560.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,521.10 / $5,971.46 / $8,997.16
| Professional | | $5,521.10 | $5,971.46 | $8,997.16 |