- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.26 / $547.75 / $704.82
| Professional | | $540.26 | $547.75 | $704.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,006.39 / $5,006.39 / $5,006.39
| Facility | | $5,006.39 | $5,006.39 | $5,006.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.00 / $1,238.00 / $1,873.00
| Professional | | $1,032.00 | $1,238.00 | $1,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.41 / $1,095.50 / $1,515.50
| Professional | | $741.41 | $1,095.50 | $1,515.50 |
- 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
- $784.48 / $960.59 / $1,910.99
| Professional | | $784.48 | $960.59 | $1,910.99 |