- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.47 / $1,218.14 / $1,422.10
| Professional | | $929.47 | $1,218.14 | $1,422.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,701.00 / $3,701.00 / $3,701.00
| Professional | | $3,701.00 | $3,701.00 | $3,701.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $641.21 / $4,201.17
| Facility | | $507.00 | $641.21 | $4,201.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.66 / $1,603.57 / $2,087.84
| Professional | | $1,239.66 | $1,603.57 | $2,087.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.00 / $1,003.00 / $2,156.00
| Facility | | $1,003.00 | $1,003.00 | $2,156.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.03 / $1,442.92 / $2,668.19
| Professional | | $1,033.03 | $1,442.92 | $2,668.19 |