- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,673.87 / $2,005.94 / $3,554.46
| Professional | | $1,673.87 | $2,005.94 | $3,554.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,136.86 / $2,136.86 / $2,780.34
| Professional | | $2,136.86 | $2,136.86 | $2,780.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,214.74 / $3,214.74 / $3,214.74
| Facility | | $3,214.74 | $3,214.74 | $3,214.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,732.53 / $2,732.53 / $3,214.74
| Professional | | $2,732.53 | $2,732.53 | $3,214.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,847.08 / $4,067.25 / $5,856.84
| Professional | | $2,847.08 | $4,067.25 | $5,856.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,832.10 / $2,098.91 / $3,217.61
| Professional | | $1,832.10 | $2,098.91 | $3,217.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.92 / $2,188.92 / $2,847.08
| Professional | | $2,188.92 | $2,188.92 | $2,847.08 |