- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,865.63 / $2,881.78 / $3,694.90
| Facility | | $2,865.63 | $2,881.78 | $3,694.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,389.30 / $2,920.74 / $4,392.10
| Professional | | $2,389.30 | $2,920.74 | $4,392.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,235.09 / $6,368.79 / $10,537.45
| Facility | | $5,235.09 | $6,368.79 | $10,537.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,132.00 / $3,171.15 / $4,812.57
| Professional | | $3,132.00 | $3,171.15 | $4,812.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,745.37 / $3,745.37 / $3,745.37
| Facility | | $3,745.37 | $3,745.37 | $3,745.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.12 / $2,734.12 / $6,578.68
| Professional | | $2,734.12 | $2,734.12 | $6,578.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.94 / $2,728.14 / $4,277.14
| Professional | | $2,167.94 | $2,728.14 | $4,277.14 |