- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.58 / $1,841.22 / $9,706.12
| Professional | | $1,547.58 | $1,841.22 | $9,706.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,962.88 / $2,962.88 / $2,962.88
| Facility | | $2,962.88 | $2,962.88 | $2,962.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,750.59 / $2,957.72 / $5,330.21
| Professional | | $1,750.59 | $2,957.72 | $5,330.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.35 / $2,448.46 / $3,355.41
| Facility | | $1,415.35 | $2,448.46 | $3,355.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,855.52 / $3,030.84 / $5,050.47
| Professional | | $1,855.52 | $3,030.84 | $5,050.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,586.40 / $3,136.63 / $3,852.10
| Professional | | $2,586.40 | $3,136.63 | $3,852.10 |