- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,389.30 / $3,131.93 / $3,243.30
| Professional | | $2,389.30 | $3,131.93 | $3,243.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,731.56 / $10,442.52 / $12,362.73
| Facility | | $7,731.56 | $10,442.52 | $12,362.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,035.97 / $3,571.73 / $4,945.17
| Professional | | $3,035.97 | $3,571.73 | $4,945.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,163.05 / $3,745.37 / $3,745.37
| Facility | | $3,163.05 | $3,745.37 | $3,745.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.12 / $2,734.12 / $2,734.12
| Professional | | $2,734.12 | $2,734.12 | $2,734.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,465.73 / $3,468.70 / $4,546.89
| Professional | | $2,465.73 | $3,468.70 | $4,546.89 |