- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.22 / $514.84 / $642.27
| Professional | | $505.22 | $514.84 | $642.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.20 / $2,767.20 / $2,767.20
| Facility | | $2,767.20 | $2,767.20 | $2,767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.00 / $1,174.00 / $1,775.00
| Professional | | $978.00 | $1,174.00 | $1,775.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.85 / $1,026.00 / $1,402.35
| Professional | | $695.85 | $1,026.00 | $1,402.35 |
- 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
- $715.89 / $1,017.63 / $1,806.99
| Professional | | $715.89 | $1,017.63 | $1,806.99 |