- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,606.93 / $7,762.47
| Professional | | $5,011.87 | $6,606.93 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,677.35 / $8,128.31
| Professional | | $4,466.84 | $4,677.35 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,585.78 / $7,585.78
| Facility | | $5,128.61 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $6,456.54 / $7,585.78
| Professional | | $912.01 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $5,370.32 / $8,317.64
| Facility | | $426.58 | $5,370.32 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,630.78 / $7,244.36
| Professional | | $2,511.89 | $3,630.78 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,122.02 / $5,370.32
| Facility | | $338.84 | $1,122.02 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $5,754.40
| Professional | | $2,754.23 | $3,630.78 | $5,754.40 |