- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.62 / $3,017.42 / $3,076.28
| Facility | | $2,796.62 | $3,017.42 | $3,076.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,589.15 / $2,914.46 / $3,237.89
| Professional | | $2,589.15 | $2,914.46 | $3,237.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,084.97 / $3,501.73 / $3,815.19
| Facility | | $3,084.97 | $3,501.73 | $3,815.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,391.28 / $3,391.28 / $3,391.28
| Professional | | $3,391.28 | $3,391.28 | $3,391.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,260.86 / $3,052.16 / $4,644.32
| Professional | | $2,260.86 | $3,052.16 | $4,644.32 |