- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.57 / $866.08 / $1,138.64
| Professional | | $846.57 | $866.08 | $1,138.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,752.00 / $2,752.00 / $2,752.00
| Facility | | $2,752.00 | $2,752.00 | $2,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.00 / $1,937.00 / $2,930.00
| Professional | | $1,614.00 | $1,937.00 | $2,930.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.84 / $1,561.28 / $2,365.25
| Professional | | $1,040.84 | $1,561.28 | $2,365.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.53 / $1,752.46 / $2,852.19
| Professional | | $1,027.53 | $1,752.46 | $2,852.19 |