- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.10 / $1,018.20 / $1,127.41
| Professional | | $750.10 | $1,018.20 | $1,127.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,427.23 / $3,278.30 / $3,881.12
| Facility | | $2,427.23 | $3,278.30 | $3,881.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.87 / $902.20 / $1,508.86
| Professional | | $766.87 | $902.20 | $1,508.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.01 / $1,473.53 / $1,473.53
| Facility | | $993.01 | $1,473.53 | $1,473.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.68 / $1,473.53 / $1,473.53
| Professional | | $1,075.68 | $1,473.53 | $1,473.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $774.09 / $1,055.83 / $1,427.44
| Professional | | $774.09 | $1,055.83 | $1,427.44 |