- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,158.19 / $2,474.73 / $2,561.06
| Facility | | $2,158.19 | $2,474.73 | $2,561.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,139.23 / $2,474.73 / $2,719.76
| Professional | | $2,139.23 | $2,474.73 | $2,719.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,072.81 / $2,253.05 / $2,253.05
| Professional | | $2,072.81 | $2,253.05 | $2,253.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.76 / $2,837.98 / $5,170.31
| Professional | | $287.76 | $2,837.98 | $5,170.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.61 / $1,457.33 / $2,281.42
| Professional | | $1,047.61 | $1,457.33 | $2,281.42 |