- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,884.03 / $5,754.40
| Facility | | $2,238.72 | $2,884.03 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,951.21 / $4,897.79
| Professional | | $2,238.72 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,235.94 / $12,302.69
| Facility | | $2,398.83 | $3,235.94 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,162.28 / $6,760.83
| Professional | | $2,884.03 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $21,877.62
| Facility | | $3,715.35 | $3,715.35 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $8,317.64
| Professional | | $2,754.23 | $2,754.23 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,981.07 / $7,079.46
| Facility | | $2,951.21 | $3,981.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $4,365.16
| Professional | | $2,089.30 | $2,754.23 | $4,365.16 |