- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.09 / $475.23 / $592.66
| Professional | | $471.09 | $475.23 | $592.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.80 / $2,428.80 / $2,428.80
| Facility | | $2,428.80 | $2,428.80 | $2,428.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.00 / $1,091.00 / $1,650.00
| Professional | | $909.00 | $1,091.00 | $1,650.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.23 / $950.45 / $1,305.65
| Professional | | $641.23 | $950.45 | $1,305.65 |
- 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
- $602.54 / $945.20 / $1,653.59
| Professional | | $602.54 | $945.20 | $1,653.59 |