- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $8,709.64
| Facility | | $3,630.78 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,365.16 / $7,244.36
| Professional | | $3,548.13 | $4,365.16 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,606.93 / $17,378.01
| Facility | | $4,786.30 | $6,606.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,456.54 / $10,964.78
| Professional | | $4,570.88 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $35,481.34
| Facility | | $4,786.30 | $4,786.30 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $12,589.25
| Professional | | $4,073.80 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,888.44 / $10,232.93
| Facility | | $3,801.89 | $5,888.44 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,265.80 / $6,606.93
| Professional | | $3,162.28 | $4,265.80 | $6,606.93 |