- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.02 / $1,633.61 / $2,890.24
| Professional | | $1,332.02 | $1,633.61 | $2,890.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,061.40 / $3,061.40 / $3,667.90
| Professional | | $3,061.40 | $3,061.40 | $3,667.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,098.39 / $2,136.26 / $2,196.78
| Professional | | $1,098.39 | $2,136.26 | $2,196.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $70.00
| Professional | | $50.00 | $50.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $879.64 / $1,055.57 / $5,780.48
| Professional | | $879.64 | $1,055.57 | $5,780.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.58 / $1,507.95 / $1,507.95
| Professional | | $678.58 | $1,507.95 | $1,507.95 |