- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,431.27 / $2,675.43 / $3,344.29
| Professional | | $2,431.27 | $2,675.43 | $3,344.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,984.27 / $2,554.31 / $3,438.77
| Facility | | $1,984.27 | $2,554.31 | $3,438.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,781.00 / $8,781.00 / $8,781.00
| Professional | | $8,781.00 | $8,781.00 | $8,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.57 / $2,318.00 / $2,318.00
| Facility | | $1,949.57 | $2,318.00 | $2,318.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.00 / $1,949.57 / $2,606.53
| Professional | | $1,539.00 | $1,949.57 | $2,606.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.14 / $2,207.66 / $2,244.57
| Professional | | $1,589.14 | $2,207.66 | $2,244.57 |