- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,235.94 / $6,456.54
| Professional | | $2,238.72 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,630.78 / $4,265.80
| Professional | | $2,137.96 | $3,630.78 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,365.16 / $4,677.35
| Facility | | $4,168.69 | $4,365.16 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,365.16 / $4,677.35
| Professional | | $4,168.69 | $4,365.16 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,311.31 / $4,786.30
| Facility | | $2,454.71 | $3,311.31 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,467.37 / $5,128.61
| Professional | | $79.43 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,073.80 / $4,786.30
| Professional | | $3,235.94 | $4,073.80 | $4,786.30 |