- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,922.69 / $1,930.43 / $2,418.63
| Facility | | $1,922.69 | $1,930.43 | $2,418.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.56 / $1,961.91 / $2,852.12
| Professional | | $1,677.56 | $1,961.91 | $2,852.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,719.97 / $3,982.27 / $7,439.94
| Facility | | $3,719.97 | $3,982.27 | $7,439.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,053.24 / $3,053.24 / $4,839.99
| Professional | | $3,053.24 | $3,053.24 | $4,839.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.07 / $2,381.07 / $2,381.07
| Facility | | $2,381.07 | $2,381.07 | $2,381.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.18 / $2,381.07 / $2,452.50
| Professional | | $1,738.18 | $2,381.07 | $2,452.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.86 / $1,911.75 / $2,831.71
| Professional | | $1,415.86 | $1,911.75 | $2,831.71 |