- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.49 / $2,390.40 / $3,378.33
| Professional | | $1,945.49 | $2,390.40 | $3,378.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.32 / $262.32 / $262.32
| Professional | | $262.32 | $262.32 | $262.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,671.66 / $2,671.66 / $2,671.66
| Facility | | $2,671.66 | $2,671.66 | $2,671.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.45 / $2,671.66 / $4,515.00
| Professional | | $318.45 | $2,671.66 | $4,515.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $515.22
| Professional | | $100.00 | $200.00 | $515.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.40 / $524.64 / $2,910.59
| Professional | | $157.40 | $524.64 | $2,910.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.11 / $1,680.84 / $3,361.94
| Professional | | $1,245.11 | $1,680.84 | $3,361.94 |