- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.48 / $647.94 / $713.78
| Professional | | $647.48 | $647.94 | $713.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.00 / $1,513.00 / $1,668.00
| Professional | | $1,135.00 | $1,513.00 | $1,668.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.85 / $948.44 / $1,306.23
| Professional | | $736.85 | $948.44 | $1,306.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.80 / $1,218.00 / $2,197.86
| Professional | | $776.80 | $1,218.00 | $2,197.86 |