- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $3,162.28
| Professional | | $467.74 | $602.56 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $870.96 / $1,000.00
| Facility | | $724.44 | $870.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $676.08
| Professional | | $645.65 | $645.65 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,122.02
| Professional | | $933.25 | $933.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $602.56 / $3,162.28
| Professional | | $467.74 | $602.56 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $933.25 / $1,621.81
| Professional | | $398.11 | $933.25 | $1,621.81 |