- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,784.03 / $2,040.25 / $9,350.04
| Professional | | $1,784.03 | $2,040.25 | $9,350.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,847.73 / $2,847.73 / $2,847.73
| Facility | | $2,847.73 | $2,847.73 | $2,847.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,139.86 / $2,847.73 / $2,847.73
| Professional | | $2,139.86 | $2,847.73 | $2,847.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,847.73 / $3,569.83 / $3,618.55
| Facility | | $2,847.73 | $3,569.83 | $3,618.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.08 / $2,466.57 / $3,767.40
| Professional | | $1,741.08 | $2,466.57 | $3,767.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,492.87 / $3,182.40 / $4,983.89
| Professional | | $2,492.87 | $3,182.40 | $4,983.89 |