- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,110.61 / $3,265.19 / $3,292.40
| Professional | | $3,110.61 | $3,265.19 | $3,292.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.30 / $2,419.23 / $3,265.19
| Facility | | $1,282.30 | $2,419.23 | $3,265.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,853.75 / $2,332.14
| Professional | | $32.34 | $1,853.75 | $2,332.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,480.35 / $9,397.43 / $15,505.75
| Facility | | $7,480.35 | $9,397.43 | $15,505.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.63 / $2,691.33 / $3,111.56
| Professional | | $2,287.63 | $2,691.33 | $3,111.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.67 / $1,929.61 / $2,729.03
| Professional | | $1,417.67 | $1,929.61 | $2,729.03 |