- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.60 / $1,061.28 / $1,877.57
| Professional | | $935.60 | $1,061.28 | $1,877.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.07 / $2,218.34 / $4,010.66
| Facility | | $614.07 | $2,218.34 | $4,010.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,535.18 / $2,046.91 / $2,788.92
| Professional | | $1,535.18 | $2,046.91 | $2,788.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.10 / $1,304.10 / $1,304.10
| Facility | | $1,304.10 | $1,304.10 | $1,304.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.00 / $952.00 / $2,545.13
| Professional | | $952.00 | $952.00 | $2,545.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.82 / $1,630.06 / $10,402.94
| Facility | | $644.82 | $1,630.06 | $10,402.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.85 / $998.83 / $1,504.59
| Professional | | $901.85 | $998.83 | $1,504.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.85 / $998.83 / $1,504.59
| Professional | | $901.85 | $998.83 | $1,504.59 |