- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,004.74 / $3,199.28 / $4,021.05
| Professional | | $3,004.74 | $3,199.28 | $4,021.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.72 / $425.50 / $4,274.57
| Facility | | $345.72 | $425.50 | $4,274.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.72 / $372.32 / $4,603.38
| Professional | | $345.72 | $372.32 | $4,603.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.00 / $2,187.00 / $5,872.68
| Facility | | $2,187.00 | $2,187.00 | $5,872.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.04 / $2,187.00 / $3,552.71
| Professional | | $418.04 | $2,187.00 | $3,552.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.52 / $2,741.85 / $4,759.00
| Professional | | $2,027.52 | $2,741.85 | $4,759.00 |