- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,698.05 / $3,480.48 / $7,602.83
| Facility | | $2,698.05 | $3,480.48 | $7,602.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,698.05 / $2,725.03 / $3,264.64
| Professional | | $2,698.05 | $2,725.03 | $3,264.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.00 / $1,974.72 / $2,575.19
| Facility | | $1,683.00 | $1,974.72 | $2,575.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.19 / $2,575.19 / $2,626.70
| Professional | | $2,575.19 | $2,575.19 | $2,626.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.33 / $2,545.33 / $2,698.05
| Facility | | $2,545.33 | $2,545.33 | $2,698.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,698.05 / $2,698.05 / $2,698.05
| Professional | | $2,698.05 | $2,698.05 | $2,698.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,477.62 / $2,698.05 / $3,188.47
| Professional | | $2,477.62 | $2,698.05 | $3,188.47 |