- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,313.92 / $2,694.05 / $3,140.98
| Professional | | $2,313.92 | $2,694.05 | $3,140.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,487.65 / $10,113.08 / $11,972.69
| Facility | | $7,487.65 | $10,113.08 | $11,972.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,365.67 / $2,783.15 / $4,654.60
| Professional | | $2,365.67 | $2,783.15 | $4,654.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.84 / $2,802.84 / $2,802.84
| Facility | | $2,802.84 | $2,802.84 | $2,802.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,382.41 / $2,802.84 / $2,802.84
| Professional | | $2,382.41 | $2,802.84 | $2,802.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.67 / $3,024.44 / $4,403.45
| Professional | | $2,282.67 | $3,024.44 | $4,403.45 |