- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.31 / $1,788.35 / $2,908.74
| Professional | | $1,485.31 | $1,788.35 | $2,908.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.00 / $564.00 / $613.00
| Professional | | $564.00 | $564.00 | $613.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.00 / $520.20 / $960.40
| Professional | | $435.00 | $520.20 | $960.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.11 / $8,444.70 / $26,542.00
| Facility | | $1,061.11 | $8,444.70 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,000.00 / $4,000.00 / $4,000.00
| Professional | | $4,000.00 | $4,000.00 | $4,000.00 |