- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.46 / $3,243.46 / $5,341.61
| Facility | | $2,601.46 | $3,243.46 | $5,341.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,608.16 / $2,608.16 / $3,078.11
| Professional | | $2,608.16 | $2,608.16 | $3,078.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.16 / $4,169.53 / $8,292.64
| Facility | | $2,608.16 | $4,169.53 | $8,292.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,608.16 / $2,608.16 / $3,062.75
| Professional | | $2,608.16 | $2,608.16 | $3,062.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.53 / $2,608.16 / $2,869.16
| Facility | | $2,460.53 | $2,608.16 | $2,869.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,608.16 / $2,608.16 / $2,829.60
| Professional | | $2,608.16 | $2,608.16 | $2,829.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,673.43 / $3,261.58 / $4,411.16
| Facility | | $2,673.43 | $3,261.58 | $4,411.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,608.16 / $2,608.16 / $3,129.79
| Professional | | $2,608.16 | $2,608.16 | $3,129.79 |