- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.41 / $2,682.99 / $3,624.33
| Professional | | $2,000.41 | $2,682.99 | $3,624.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,430.93 / $5,169.22 / $9,345.75
| Facility | | $1,430.93 | $5,169.22 | $9,345.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,577.32 / $4,769.76 / $6,498.80
| Professional | | $3,577.32 | $4,769.76 | $6,498.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,813.78 / $3,813.78 / $3,813.78
| Facility | | $3,813.78 | $3,813.78 | $3,813.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.06 / $2,784.06 / $6,212.25
| Professional | | $2,784.06 | $2,784.06 | $6,212.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.20 / $3,983.78 / $23,822.60
| Facility | | $1,440.20 | $3,983.78 | $23,822.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.28 / $2,230.86 / $3,437.68
| Professional | | $2,016.28 | $2,230.86 | $3,437.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.28 / $2,230.86 / $3,360.47
| Professional | | $2,016.28 | $2,230.86 | $3,360.47 |