- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,839.76 / $3,639.59 / $4,999.18
| Professional | | $2,839.76 | $3,639.59 | $4,999.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,123.38 / $7,670.72 / $13,868.35
| Facility | | $2,123.38 | $7,670.72 | $13,868.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,308.46 / $7,077.94 / $9,643.70
| Professional | | $5,308.46 | $7,077.94 | $9,643.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,790.37 / $3,790.37 / $3,790.37
| Facility | | $3,790.37 | $3,790.37 | $3,790.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,766.97 / $2,766.97 / $7,784.25
| Professional | | $2,766.97 | $2,766.97 | $7,784.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.69 / $5,404.15 / $32,412.74
| Facility | | $1,953.69 | $5,404.15 | $32,412.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.17 / $3,026.25 / $4,663.35
| Professional | | $2,735.17 | $3,026.25 | $4,663.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.17 / $3,026.25 / $4,558.62
| Professional | | $2,735.17 | $3,026.25 | $4,558.62 |