- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.06 / $1,857.07 / $6,951.16
| Professional | | $1,857.06 | $1,857.07 | $6,951.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.14 / $2,039.14 / $2,039.14
| Facility | | $2,039.14 | $2,039.14 | $2,039.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,039.14 / $2,039.14 / $2,039.14
| Professional | | $2,039.14 | $2,039.14 | $2,039.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.55 / $1,857.07 / $2,655.61
| Facility | | $768.55 | $1,857.07 | $2,655.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.65 / $526.50 / $2,300.19
| Facility | | $373.65 | $526.50 | $2,300.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,813.38 / $1,813.38 / $2,266.73
| Professional | | $1,813.38 | $1,813.38 | $2,266.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.07 / $2,250.34 / $2,625.39
| Professional | | $2,119.07 | $2,250.34 | $2,625.39 |