- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,463.94 / $2,463.94 / $2,956.73
| Facility | | $2,463.94 | $2,463.94 | $2,956.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.96 / $1,954.17 / $2,947.18
| Professional | | $1,911.96 | $1,954.17 | $2,947.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,375.91 / $4,375.91 / $5,187.20
| Facility | | $4,375.91 | $4,375.91 | $5,187.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,555.87 / $2,693.73 / $2,693.73
| Professional | | $2,555.87 | $2,693.73 | $2,693.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,502.67 / $2,502.67 / $2,502.67
| Facility | | $2,502.67 | $2,502.67 | $2,502.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.95 / $1,826.95 / $2,667.97
| Professional | | $1,826.95 | $1,826.95 | $2,667.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,542.98 / $3,542.98 / $10,935.41
| Professional | | $3,542.98 | $3,542.98 | $10,935.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.40 / $2,183.09 / $3,009.91
| Professional | | $1,455.40 | $2,183.09 | $3,009.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,277.42 / $3,605.16 / $4,588.39
| Professional | | $3,277.42 | $3,605.16 | $4,588.39 |