- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.41 / $535.83 / $678.03
| Professional | | $535.41 | $535.83 | $678.03 |
- 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
- $1,026.00 / $1,231.00 / $1,862.00
| Professional | | $1,026.00 | $1,231.00 | $1,862.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.06 / $1,070.82 / $1,484.59
| Professional | | $729.06 | $1,070.82 | $1,484.59 |
- 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
- $833.64 / $1,076.03 / $2,069.61
| Professional | | $833.64 | $1,076.03 | $2,069.61 |