- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.71 / $2,013.03 / $2,712.14
| Facility | | $1,971.71 | $2,013.03 | $2,712.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,620.85 / $2,028.68 / $2,708.74
| Professional | | $1,620.85 | $2,028.68 | $2,708.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,785.55 / $4,208.67 / $7,496.98
| Facility | | $3,785.55 | $4,208.67 | $7,496.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,076.23 / $2,148.37 / $3,186.73
| Professional | | $2,076.23 | $2,148.37 | $3,186.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.07 / $2,160.07 / $2,223.85
| Facility | | $2,160.07 | $2,160.07 | $2,223.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.85 / $2,160.07 / $2,634.85
| Professional | | $1,576.85 | $2,160.07 | $2,634.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.26 / $1,943.92 / $2,752.37
| Professional | | $1,481.26 | $1,943.92 | $2,752.37 |