- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.36 / $2,504.26 / $3,028.90
| Professional | | $2,231.36 | $2,504.26 | $3,028.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,220.47 / $9,752.21 / $11,545.48
| Facility | | $7,220.47 | $9,752.21 | $11,545.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,281.26 / $2,683.84 / $4,488.53
| Professional | | $2,281.26 | $2,683.84 | $4,488.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.32 / $3,006.81 / $3,006.81
| Facility | | $2,951.32 | $3,006.81 | $3,006.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.96 / $3,006.81 / $3,006.81
| Professional | | $2,194.96 | $3,006.81 | $3,006.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,302.73 / $2,916.52 / $4,246.33
| Professional | | $2,302.73 | $2,916.52 | $4,246.33 |