- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,568.83 / $2,574.02 / $3,231.45
| Facility | | $2,568.83 | $2,574.02 | $3,231.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,196.48 / $2,621.25 / $3,810.62
| Professional | | $2,196.48 | $2,621.25 | $3,810.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,970.12 / $5,320.58 / $9,604.04
| Facility | | $4,970.12 | $5,320.58 | $9,604.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,752.64 / $2,779.11 / $3,985.60
| Professional | | $2,752.64 | $2,779.11 | $3,985.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.10 / $3,294.10 / $3,294.10
| Facility | | $3,294.10 | $3,294.10 | $3,294.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,404.69 / $3,223.30 / $3,511.67
| Professional | | $2,404.69 | $3,223.30 | $3,511.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,929.22 / $2,540.44 / $3,599.32
| Professional | | $1,929.22 | $2,540.44 | $3,599.32 |