- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $707.95 / $1,023.29
| Professional | | $489.78 | $707.95 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $1,122.02
| Facility | | $776.25 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $1,122.02
| Professional | | $562.34 | $912.01 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $2,041.74
| Facility | | $831.76 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $2,041.74
| Professional | | $831.76 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $1,412.54
| Facility | | $602.56 | $1,000.00 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $851.14 / $1,122.02
| Professional | | $79.43 | $851.14 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $676.08
| Facility | | $512.86 | $645.65 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $524.81 / $588.84
| Professional | | $467.74 | $524.81 | $588.84 |