- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,121.52 / $2,172.55 / $3,614.61
| Professional | | $2,121.52 | $2,172.55 | $3,614.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.72 / $4,471.26 / $8,083.86
| Facility | | $1,237.72 | $4,471.26 | $8,083.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,094.30 / $4,125.74 / $5,621.32
| Professional | | $3,094.30 | $4,125.74 | $5,621.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,886.72 / $2,886.72 / $2,886.72
| Facility | | $2,886.72 | $2,886.72 | $2,886.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,107.31 / $2,107.31 / $5,599.88
| Professional | | $2,107.31 | $2,107.31 | $5,599.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.75 / $3,150.08 / $22,493.11
| Facility | | $1,389.75 | $3,150.08 | $22,493.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.66 / $2,152.71 / $3,317.27
| Professional | | $1,945.66 | $2,152.71 | $3,317.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.66 / $2,152.71 / $3,242.76
| Professional | | $1,945.66 | $2,152.71 | $3,242.76 |