- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,990.74 / $2,106.84 / $3,312.12
| Professional | | $1,990.74 | $2,106.84 | $3,312.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.65 / $4,059.18 / $7,338.83
| Facility | | $1,123.65 | $4,059.18 | $7,338.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,809.12 / $3,745.49 / $5,103.22
| Professional | | $2,809.12 | $3,745.49 | $5,103.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,600.52 / $3,600.52 / $3,600.52
| Facility | | $3,600.52 | $3,600.52 | $3,600.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,060.44 / $3,060.44 / $5,262.38
| Professional | | $3,060.44 | $3,060.44 | $5,262.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.88 / $3,128.29 / $21,186.55
| Facility | | $1,304.88 | $3,128.29 | $21,186.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.83 / $2,021.25 / $3,114.68
| Professional | | $1,826.83 | $2,021.25 | $3,114.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.83 / $2,021.25 / $3,044.72
| Professional | | $1,826.83 | $2,021.25 | $3,044.72 |