- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $776.25 / $1,380.38
| Professional | | $724.44 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,290.87 / $2,754.23
| Professional | | $1,513.56 | $2,290.87 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,513.56 / $2,187.76
| Professional | | $1,096.48 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $25,703.96
| Facility | | $6,918.31 | $6,918.31 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $3,467.37
| Professional | | $954.99 | $1,445.44 | $3,467.37 |