- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.10 / $268.36 / $3,637.47
| Professional | | $55.10 | $268.36 | $3,637.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.48 / $66.12 / $74.72
| Professional | | $61.48 | $66.12 | $74.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,506.62 / $6,964.14 / $9,451.70
| Professional | | $4,506.62 | $6,964.14 | $9,451.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Facility | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,685.71 / $2,199.15 / $4,686.03
| Professional | | $1,685.71 | $2,199.15 | $4,686.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,964.14 / $6,964.14 / $7,246.30
| Professional | | $6,964.14 | $6,964.14 | $7,246.30 |