- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,535.21 / $2,573.96 / $2,953.03
| Facility | | $2,535.21 | $2,573.96 | $2,953.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,204.03 / $2,535.21 / $3,666.98
| Professional | | $2,204.03 | $2,535.21 | $3,666.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,734.26 / $5,319.41 / $9,657.89
| Facility | | $4,734.26 | $5,319.41 | $9,657.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,694.05 / $2,694.05 / $3,975.93
| Professional | | $2,694.05 | $2,694.05 | $3,975.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.84 / $2,802.84 / $2,802.84
| Facility | | $2,802.84 | $2,802.84 | $2,802.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,382.41 / $2,793.39 / $2,886.93
| Professional | | $2,382.41 | $2,793.39 | $2,886.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,864.83 / $2,507.19 / $3,564.45
| Professional | | $1,864.83 | $2,507.19 | $3,564.45 |