- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,171.94 / $2,196.84 / $2,699.73
| Facility | | $2,171.94 | $2,196.84 | $2,699.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,958.20 / $2,213.69 / $3,304.15
| Professional | | $1,958.20 | $2,213.69 | $3,304.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,993.44 / $4,827.08 / $7,986.62
| Facility | | $3,993.44 | $4,827.08 | $7,986.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,381.38 / $2,396.26 / $3,599.89
| Professional | | $2,381.38 | $2,396.26 | $3,599.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.17 / $2,728.17 / $2,728.17
| Facility | | $2,728.17 | $2,728.17 | $2,728.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.56 / $1,991.56 / $4,501.49
| Professional | | $1,991.56 | $1,991.56 | $4,501.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.26 / $2,190.25 / $3,137.22
| Professional | | $1,672.26 | $2,190.25 | $3,137.22 |