- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,897.79 / $6,025.60
| Professional | | $3,467.37 | $4,897.79 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $8,128.31
| Facility | | $602.56 | $602.56 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $8,709.64
| Professional | | $645.65 | $645.65 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,090.30 / $6,165.95
| Facility | | $933.25 | $3,090.30 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $3,090.30 / $4,466.84
| Professional | | $645.65 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $616.60 / $4,073.80
| Facility | | $512.86 | $616.60 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,019.95 / $5,011.87
| Professional | | $2,344.23 | $3,019.95 | $5,011.87 |