- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,187.76 / $8,511.38
| Facility | | $2,137.96 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,187.76 / $3,467.37
| Professional | | $1,479.11 | $2,187.76 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,570.88 / $5,370.32
| Professional | | $3,715.35 | $4,570.88 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,548.13 / $5,888.44
| Professional | | $2,818.38 | $3,548.13 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $6,456.54
| Facility | | $2,137.96 | $2,818.38 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,981.07 / $5,011.87
| Professional | | $2,344.23 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,981.07 / $5,370.32
| Professional | | $2,344.23 | $3,981.07 | $5,370.32 |