- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.51 / $729.74 / $922.72
| Professional | | $729.51 | $729.74 | $922.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.00 / $1,675.00 / $2,536.00
| Professional | | $1,396.00 | $1,675.00 | $2,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.27 / $1,240.17 / $2,022.21
| Professional | | $788.27 | $1,240.17 | $2,022.21 |
- 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
- $1,015.28 / $1,443.22 / $2,243.34
| Professional | | $1,015.28 | $1,443.22 | $2,243.34 |