- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.28 / $2,924.51 / $3,350.61
| Facility | | $2,719.28 | $2,924.51 | $3,350.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,719.28 / $3,274.56 / $4,740.60
| Professional | | $2,719.28 | $3,274.56 | $4,740.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,799.01 / $3,799.01 / $3,799.01
| Facility | | $3,799.01 | $3,799.01 | $3,799.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,229.16 / $3,229.16 / $3,799.01
| Professional | | $3,229.16 | $3,229.16 | $3,799.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,871.95 / $4,387.53 / $6,369.31
| Professional | | $2,871.95 | $4,387.53 | $6,369.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,095.44 / $5,095.44 / $5,095.44
| Professional | | $5,095.44 | $5,095.44 | $5,095.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.19 / $3,177.58 / $4,303.13
| Professional | | $2,735.19 | $3,177.58 | $4,303.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,438.30 / $3,438.30 / $6,369.31
| Professional | | $3,438.30 | $3,438.30 | $6,369.31 |