- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.16 / $595.62 / $750.12
| Professional | | $587.16 | $595.62 | $750.12 |
- 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
- $1,127.00 / $1,352.00 / $2,046.00
| Professional | | $1,127.00 | $1,352.00 | $2,046.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.04 / $1,171.57 / $1,645.22
| Professional | | $781.04 | $1,171.57 | $1,645.22 |
- 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
- $626.70 / $1,152.75 / $1,895.41
| Professional | | $626.70 | $1,152.75 | $1,895.41 |