- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,242.82 / $2,412.09 / $2,763.52
| Facility | | $2,242.82 | $2,412.09 | $2,763.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,242.82 / $2,763.52 / $3,909.98
| Professional | | $2,242.82 | $2,763.52 | $3,909.98 |
- 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 / $2,878.67 / $3,943.38
| Professional | | $2,878.67 | $2,878.67 | $3,943.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.72 / $3,497.05 / $3,497.05
| Facility | | $1,819.72 | $3,497.05 | $3,497.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,503.82 / $3,497.05 / $5,253.31
| Professional | | $2,503.82 | $3,497.05 | $5,253.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.53 / $2,237.73 / $2,461.51
| Professional | | $1,454.53 | $2,237.73 | $2,461.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,255.94 / $2,620.82 / $3,948.77
| Professional | | $2,255.94 | $2,620.82 | $3,948.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,237.73 / $2,237.73 / $3,178.82
| Professional | | $2,237.73 | $2,237.73 | $3,178.82 |