- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.27 / $3,770.85 / $7,105.75
| Professional | | $1,092.27 | $3,770.85 | $7,105.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.75 / $1,191.35 / $2,799.19
| Professional | | $666.75 | $1,191.35 | $2,799.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,815.57 / $6,815.57 / $6,815.57
| Professional | | $6,815.57 | $6,815.57 | $6,815.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,408.86
| Professional | | $32.34 | $32.34 | $1,408.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.75 / $1,466.75 / $1,466.75
| Professional | | $1,466.75 | $1,466.75 | $1,466.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,538.33 / $1,977.81 / $2,399.79
| Professional | | $1,538.33 | $1,977.81 | $2,399.79 |