- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.83 / $4,024.39 / $33,758.40
| Professional | | $795.83 | $4,024.39 | $33,758.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.93 / $1,200.93 / $1,200.93
| Facility | | $1,200.93 | $1,200.93 | $1,200.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.93 / $1,322.69 / $11,667.35
| Professional | | $1,200.93 | $1,322.69 | $11,667.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.13 / $10,455.25 / $11,780.31
| Facility | | $743.13 | $10,455.25 | $11,780.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.72 / $5,566.33 / $10,871.95
| Professional | | $783.72 | $5,566.33 | $10,871.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,249.89 / $10,356.27 / $15,993.23
| Professional | | $8,249.89 | $10,356.27 | $15,993.23 |