- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,176.64 / $2,288.80 / $5,378.09
| Facility | | $2,176.64 | $2,288.80 | $5,378.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.48 / $2,179.81 / $2,906.34
| Professional | | $2,137.48 | $2,179.81 | $2,906.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,616.17 / $4,712.92 / $8,915.45
| Facility | | $2,616.17 | $4,712.92 | $8,915.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,048.42 / $2,156.23 / $2,156.23
| Professional | | $2,048.42 | $2,156.23 | $2,156.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $2,116.32 / $2,116.32
| Professional | | $1,303.95 | $2,116.32 | $2,116.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.32 / $3,174.48 / $6,056.50
| Facility | | $2,116.32 | $3,174.48 | $6,056.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,176.64 / $2,561.23
| Professional | | $2,116.32 | $2,176.64 | $2,561.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,390.51 / $2,430.22 / $2,433.76
| Professional | | $2,390.51 | $2,430.22 | $2,433.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,116.32 / $2,116.32 / $2,539.58
| Professional | | $2,116.32 | $2,116.32 | $2,539.58 |