- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.45 / $747.35 / $944.58
| Professional | | $741.45 | $747.35 | $944.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,418.00 / $1,702.00 / $2,574.00
| Professional | | $1,418.00 | $1,702.00 | $2,574.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.19 / $1,426.78 / $2,062.15
| Professional | | $951.19 | $1,426.78 | $2,062.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.82 / $1,434.14 / $2,324.41
| Professional | | $777.82 | $1,434.14 | $2,324.41 |