- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.11 / $2,788.30 / $2,905.96
| Professional | | $2,054.11 | $2,788.30 | $2,905.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,646.91 / $8,977.52 / $10,628.33
| Facility | | $6,646.91 | $8,977.52 | $10,628.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.04 / $2,470.64 / $4,131.96
| Professional | | $2,100.04 | $2,470.64 | $4,131.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.30 / $3,798.08 / $3,798.08
| Facility | | $2,719.30 | $3,798.08 | $3,798.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,772.60 / $3,798.08 / $3,798.08
| Professional | | $2,772.60 | $3,798.08 | $3,798.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.82 / $2,975.84 / $3,909.01
| Professional | | $2,119.82 | $2,975.84 | $3,909.01 |