- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $1,412.54
| Professional | | $309.03 | $407.38 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,862.09 / $2,137.96
| Facility | | $1,348.96 | $1,862.09 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $1,000.00
| Professional | | $363.08 | $489.78 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $537.03
| Facility | | $457.09 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $457.09
| Professional | | $331.13 | $331.13 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $954.99
| Facility | | $467.74 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $776.25
| Professional | | $416.87 | $501.19 | $776.25 |