- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.11 / $2,198.62 / $11,598.10
| Professional | | $1,847.11 | $2,198.62 | $11,598.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,521.81 / $3,521.81 / $4,226.17
| Professional | | $3,521.81 | $3,521.81 | $4,226.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,521.81 / $3,521.81 / $3,521.81
| Facility | | $3,521.81 | $3,521.81 | $3,521.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.73 / $3,521.81 / $5,936.71
| Professional | | $2,114.73 | $3,521.81 | $5,936.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.36 / $3,222.04 / $4,019.54
| Facility | | $2,167.36 | $3,222.04 | $4,019.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.46 / $3,605.09 / $6,007.37
| Professional | | $2,194.46 | $3,605.09 | $6,007.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,079.43 / $3,730.55 / $4,729.18
| Professional | | $3,079.43 | $3,730.55 | $4,729.18 |