- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.64 / $1,432.77 / $1,818.08
| Professional | | $1,167.64 | $1,432.77 | $1,818.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,595.00 / $1,658.80 / $2,010.87
| Professional | | $1,595.00 | $1,658.80 | $2,010.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.52 / $1,436.52 / $1,545.12
| Facility | | $1,436.52 | $1,436.52 | $1,545.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.04 / $1,221.04 / $3,007.50
| Professional | | $1,221.04 | $1,221.04 | $3,007.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.47 / $1,432.77 / $1,818.08
| Facility | | $710.47 | $1,432.77 | $1,818.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.00 / $1,672.00 / $1,672.00
| Professional | | $1,672.00 | $1,672.00 | $1,672.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.52 / $753.91 / $1,340.29
| Professional | | $100.52 | $753.91 | $1,340.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.29 / $1,092.43 / $1,462.73
| Professional | | $728.29 | $1,092.43 | $1,462.73 |