- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,218.23 / $2,890.61 / $10,885.80
| Professional | | $2,218.23 | $2,890.61 | $10,885.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,279.94 / $3,279.94 / $3,279.94
| Facility | | $3,279.94 | $3,279.94 | $3,279.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,762.73 / $3,279.94 / $3,543.80
| Professional | | $1,762.73 | $3,279.94 | $3,543.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,622.58 / $2,231.04 / $3,412.95
| Facility | | $1,622.58 | $2,231.04 | $3,412.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.79 / $3,279.94 / $4,309.89
| Professional | | $1,991.79 | $3,279.94 | $4,309.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,849.37 / $3,451.35 / $3,875.20
| Professional | | $2,849.37 | $3,451.35 | $3,875.20 |