- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,019.85 / $2,630.28 / $2,708.32
| Professional | | $2,019.85 | $2,630.28 | $2,708.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.19 / $423.36 / $765.41
| Facility | | $117.19 | $423.36 | $765.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,285.23 / $3,046.98 / $5,065.60
| Professional | | $2,285.23 | $3,046.98 | $5,065.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,837.98 / $2,837.98 / $5,170.31
| Professional | | $2,837.98 | $2,837.98 | $5,170.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.09 / $2,386.53 / $18,269.96
| Facility | | $346.09 | $2,386.53 | $18,269.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.31 / $1,713.46 / $2,245.23
| Professional | | $1,142.31 | $1,713.46 | $2,245.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.27 / $1,713.46 / $2,245.23
| Professional | | $1,270.27 | $1,713.46 | $2,245.23 |