- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,128.61 / $7,762.47
| Facility | | $812.83 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $1,905.46
| Professional | | $630.96 | $724.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $2,818.38 / $7,079.46
| Professional | | $776.25 | $2,818.38 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $2,089.30
| Professional | | $691.83 | $831.76 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,621.81 / $1,819.70
| Professional | | $776.25 | $1,621.81 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $14,791.08 / $26,915.35
| Facility | | $3,311.31 | $14,791.08 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $1,737.80
| Professional | | $602.56 | $794.33 | $1,737.80 |