- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,976.55 / $2,490.44 / $4,306.89
| Facility | | $1,976.55 | $2,490.44 | $4,306.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,391.63
| Professional | | $2,016.42 | $2,016.42 | $2,391.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,016.42
| Facility | | $2,016.42 | $2,016.42 | $2,016.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,016.42
| Professional | | $2,016.42 | $2,016.42 | $2,016.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,560.91 / $9,626.15 / $10,082.10
| Facility | | $2,560.91 | $9,626.15 | $10,082.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.42 / $2,016.42 / $2,159.69
| Professional | | $2,016.42 | $2,016.42 | $2,159.69 |