- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,928.79 / $2,959.98 / $3,481.32
| Facility | | $2,928.79 | $2,959.98 | $3,481.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,412.09 / $3,017.14 / $4,134.35
| Professional | | $2,412.09 | $3,017.14 | $4,134.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,553.25 / $6,705.52 / $11,188.36
| Facility | | $5,553.25 | $6,705.52 | $11,188.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,155.15 / $3,194.59 / $5,009.10
| Professional | | $3,155.15 | $3,194.59 | $5,009.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,943.38 / $3,943.38 / $3,943.38
| Facility | | $3,943.38 | $3,943.38 | $3,943.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,878.67 / $3,858.65 / $4,061.68
| Professional | | $2,878.67 | $3,858.65 | $4,061.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,255.94 / $2,908.98 / $4,156.60
| Professional | | $2,255.94 | $2,908.98 | $4,156.60 |