- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.47 / $2,474.42 / $3,093.03
| Professional | | $2,002.47 | $2,474.42 | $3,093.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.77 / $1,795.53 / $2,244.41
| Facility | | $1,102.77 | $1,795.53 | $2,244.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,494.34 / $5,494.34 / $5,494.34
| Professional | | $5,494.34 | $5,494.34 | $5,494.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.00 / $1,853.00 / $1,853.00
| Facility | | $1,853.00 | $1,853.00 | $1,853.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.00 / $1,752.00 / $2,366.96
| Professional | | $1,591.00 | $1,752.00 | $2,366.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.02 / $1,133.02 / $1,347.83
| Professional | | $1,133.02 | $1,133.02 | $1,347.83 |