- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.44 / $2,030.39 / $9,743.02
| Professional | | $1,832.44 | $2,030.39 | $9,743.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.78 / $2,960.78 / $2,960.78
| Facility | | $2,960.78 | $2,960.78 | $2,960.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,189.46 / $2,960.78 / $2,960.78
| Professional | | $2,189.46 | $2,960.78 | $2,960.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.78 / $3,690.64 / $3,730.35
| Facility | | $2,960.78 | $3,690.64 | $3,730.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.86 / $2,569.69 / $3,924.90
| Professional | | $1,813.86 | $2,569.69 | $3,924.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,881.85 / $3,325.21 / $5,187.38
| Professional | | $2,881.85 | $3,325.21 | $5,187.38 |