- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,548.13 / $7,079.46
| Facility | | $2,691.53 | $3,548.13 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,630.78 / $6,165.95
| Professional | | $2,630.27 | $3,630.78 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,801.89 / $14,791.08
| Facility | | $2,818.38 | $3,801.89 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $8,128.31
| Professional | | $3,630.78 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $27,542.29
| Facility | | $4,677.35 | $4,677.35 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $10,715.19
| Professional | | $3,467.37 | $3,467.37 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,677.35 / $8,317.64
| Facility | | $4,073.80 | $4,677.35 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,388.44 / $5,128.61
| Professional | | $2,454.71 | $3,388.44 | $5,128.61 |