- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,305.73 / $2,609.12 / $2,942.84
| Professional | | $2,305.73 | $2,609.12 | $2,942.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $2,313.90 / $5,801.58
| Professional | | $239.16 | $2,313.90 | $5,801.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.78 / $2,727.75 / $6,803.43
| Facility | | $2,578.78 | $2,727.75 | $6,803.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.22 / $1,820.32 / $15,108.62
| Professional | | $1,274.22 | $1,820.32 | $15,108.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.22 / $1,820.32 / $3,428.26
| Professional | | $1,274.22 | $1,820.32 | $3,428.26 |