- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,454.71 / $8,511.38
| Facility | | $2,398.83 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $3,467.37
| Professional | | $1,995.26 | $2,454.71 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,248.07 / $6,165.95
| Professional | | $4,265.80 | $5,248.07 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,570.88 / $7,943.28
| Professional | | $3,162.28 | $4,570.88 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $7,244.36
| Facility | | $2,454.71 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,365.16 / $5,248.07
| Professional | | $2,398.83 | $4,365.16 | $5,248.07 |
- 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
- $2,398.83 / $4,365.16 / $6,025.60
| Professional | | $2,398.83 | $4,365.16 | $6,025.60 |