- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,769.57 / $2,083.36 / $10,934.90
| Professional | | $1,769.57 | $2,083.36 | $10,934.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,342.51 / $3,342.51 / $3,342.51
| Facility | | $3,342.51 | $3,342.51 | $3,342.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,876.19 / $3,329.11 / $6,051.50
| Professional | | $1,876.19 | $3,329.11 | $6,051.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,740.06 / $2,681.49 / $3,824.10
| Facility | | $1,740.06 | $2,681.49 | $3,824.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.65 / $3,416.37 / $5,692.90
| Professional | | $2,097.65 | $3,416.37 | $5,692.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,918.22 / $3,601.21 / $4,613.97
| Professional | | $2,918.22 | $3,601.21 | $4,613.97 |