- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,467.37 / $4,786.30
| Professional | | $2,691.53 | $3,467.37 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $4,168.69
| Facility | | $3,467.37 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $3,467.37 / $3,548.13
| Professional | | $501.19 | $3,467.37 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,495.41 / $19,054.61
| Professional | | $2,344.23 | $5,495.41 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,778.28 / $3,715.35
| Facility | | $234.42 | $1,778.28 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,090.30 / $5,495.41
| Professional | | $2,089.30 | $3,090.30 | $5,495.41 |