- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $6,918.31
| Facility | | $2,691.53 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,951.21 / $3,630.78
| Professional | | $2,570.40 | $2,951.21 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,413.10 / $8,709.64
| Professional | | $5,128.61 | $7,413.10 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $5,623.41
| Professional | | $4,466.84 | $4,466.84 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $6,918.31
| Facility | | $2,344.23 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $7,762.47
| Professional | | $1,621.81 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $6,606.93
| Professional | | $1,621.81 | $3,981.07 | $6,606.93 |