- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.73 / $1,745.32 / $2,259.76
| Professional | | $1,664.73 | $1,745.32 | $2,259.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,386.93 / $7,275.74 / $8,613.62
| Facility | | $5,386.93 | $7,275.74 | $8,613.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.30 / $2,488.59 / $3,445.51
| Professional | | $2,115.30 | $2,488.59 | $3,445.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.81 / $1,815.81 / $2,203.83
| Facility | | $1,815.81 | $1,815.81 | $2,203.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.54 / $1,815.81 / $1,815.81
| Professional | | $1,325.54 | $1,815.81 | $1,815.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,316.35 / $2,142.37 / $3,168.02
| Professional | | $1,316.35 | $2,142.37 | $3,168.02 |