- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.92 / $3,100.40 / $3,100.40
| Professional | | $2,282.92 | $3,100.40 | $3,100.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.75 / $147.75 / $184.69
| Facility | | $147.75 | $147.75 | $184.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,881.16 / $3,841.55 / $6,386.58
| Professional | | $2,881.16 | $3,841.55 | $6,386.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.64 / $2,672.64 / $2,672.64
| Facility | | $2,672.64 | $2,672.64 | $2,672.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.73 / $2,672.64 / $4,729.50
| Professional | | $2,271.73 | $2,672.64 | $4,729.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.69 / $3,129.41 / $19,176.53
| Facility | | $2,496.69 | $3,129.41 | $19,176.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.64 / $2,047.28 / $3,120.86
| Professional | | $1,444.64 | $2,047.28 | $3,120.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.63 / $2,047.28 / $3,120.86
| Professional | | $1,694.63 | $2,047.28 | $3,120.86 |