- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.52 / $2,298.17 / $2,885.12
| Facility | | $2,293.52 | $2,298.17 | $2,885.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,980.35 / $2,340.36 / $3,402.20
| Professional | | $1,980.35 | $2,340.36 | $3,402.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,437.52 / $4,750.35 / $8,875.04
| Facility | | $4,437.52 | $4,750.35 | $8,875.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,550.15 / $2,731.58 / $3,704.46
| Professional | | $2,550.15 | $2,731.58 | $3,704.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.06 / $2,941.06 / $2,941.06
| Facility | | $2,941.06 | $2,941.06 | $2,941.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,146.96 / $2,146.96 / $4,881.27
| Professional | | $2,146.96 | $2,146.96 | $4,881.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,689.48 / $2,280.27 / $3,208.21
| Professional | | $1,689.48 | $2,280.27 | $3,208.21 |