- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.55 / $541.45 / $674.59
| Professional | | $534.55 | $541.45 | $674.59 |
- 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
- $1,045.00 / $1,254.00 / $1,896.00
| Professional | | $1,045.00 | $1,254.00 | $1,896.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.71 / $979.06 / $1,496.44
| Professional | | $652.71 | $979.06 | $1,496.44 |
- 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
- $496.28 / $1,044.79 / $1,624.02
| Professional | | $496.28 | $1,044.79 | $1,624.02 |