- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,196.84 / $2,381.38 / $2,982.06
| Professional | | $2,196.84 | $2,381.38 | $2,982.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,108.79 / $9,601.35 / $11,366.88
| Facility | | $7,108.79 | $9,601.35 | $11,366.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,245.98 / $2,642.33 / $4,419.09
| Professional | | $2,245.98 | $2,642.33 | $4,419.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.17 / $2,728.17 / $2,908.28
| Facility | | $2,728.17 | $2,728.17 | $2,908.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.56 / $1,991.56 / $1,991.56
| Professional | | $1,991.56 | $1,991.56 | $1,991.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,978.08 / $2,871.40 / $4,180.64
| Professional | | $1,978.08 | $2,871.40 | $4,180.64 |