- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.40 / $2,160.21 / $2,403.62
| Professional | | $1,591.40 | $2,160.21 | $2,403.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,149.63 / $6,955.27 / $8,234.21
| Facility | | $5,149.63 | $6,955.27 | $8,234.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.99 / $1,914.11 / $3,201.21
| Professional | | $1,626.99 | $1,914.11 | $3,201.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.75 / $3,141.52 / $3,141.52
| Facility | | $2,106.75 | $3,141.52 | $3,141.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.31 / $3,141.52 / $3,141.52
| Professional | | $2,293.31 | $3,141.52 | $3,141.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.31 / $2,321.64 / $3,028.47
| Professional | | $1,642.31 | $2,321.64 | $3,028.47 |