- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,684.78 / $2,406.53 / $8,999.11
| Professional | | $1,684.78 | $2,406.53 | $8,999.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,586.41 / $2,586.41 / $3,103.69
| Professional | | $2,586.41 | $2,586.41 | $3,103.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,586.41 / $2,586.41 / $2,586.41
| Facility | | $2,586.41 | $2,586.41 | $2,586.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,104.10 / $2,586.41 / $2,586.41
| Professional | | $2,104.10 | $2,586.41 | $2,586.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,586.41 / $3,302.65 / $3,384.51
| Facility | | $2,586.41 | $3,302.65 | $3,384.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,592.59 / $2,256.21 / $3,446.10
| Professional | | $1,592.59 | $2,256.21 | $3,446.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,591.31 / $3,087.60 / $4,530.66
| Professional | | $2,591.31 | $3,087.60 | $4,530.66 |