- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $4,466.84
| Facility | | $1,737.80 | $2,344.23 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,905.46 / $2,344.23
| Professional | | $1,698.24 | $1,905.46 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $5,623.41
| Professional | | $3,311.31 | $4,786.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,630.78
| Professional | | $2,884.03 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $4,466.84
| Facility | | $1,513.56 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,235.94 / $5,011.87
| Professional | | $1,047.13 | $3,235.94 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,754.23 / $4,265.80
| Professional | | $1,047.13 | $2,754.23 | $4,265.80 |