- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,071.52
| Professional | | $851.14 | $851.14 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $1,047.13
| Professional | | $151.36 | $151.36 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $1,621.81
| Facility | | $575.44 | $794.33 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $4,168.69
| Professional | | $741.31 | $977.24 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Professional | | $794.33 | $794.33 | $794.33 |