- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.67 / $2,448.03 / $28,721.06
| Professional | | $1,005.67 | $2,448.03 | $28,721.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $1,528.58
| Facility | | $55.00 | $55.00 | $1,528.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.44 / $28,868.39 / $28,868.39
| Professional | | $2,578.44 | $28,868.39 | $28,868.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.83 / $802.47 / $9,815.32
| Facility | | $650.83 | $802.47 | $9,815.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.40 / $753.40 / $753.40
| Professional | | $753.40 | $753.40 | $753.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.83 / $802.47 / $9,815.32
| Facility | | $650.83 | $802.47 | $9,815.32 |