- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,660.81 / $1,933.64 / $2,254.42
| Professional | | $1,660.81 | $1,933.64 | $2,254.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,374.23 / $7,258.57 / $8,593.29
| Facility | | $5,374.23 | $7,258.57 | $8,593.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,697.94 / $1,997.58 / $3,340.81
| Professional | | $1,697.94 | $1,997.58 | $3,340.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,861.13 / $2,861.13 / $2,861.13
| Facility | | $2,861.13 | $2,861.13 | $2,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,431.96 / $2,861.13 / $2,861.13
| Professional | | $2,431.96 | $2,861.13 | $2,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,638.37 / $2,170.76 / $3,160.54
| Professional | | $1,638.37 | $2,170.76 | $3,160.54 |