- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.21 / $542.21 / $656.58
| Professional | | $542.21 | $542.21 | $656.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.00 / $935.00 / $1,130.00
| Professional | | $701.00 | $935.00 | $1,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.30 / $810.16 / $1,151.84
| Professional | | $601.30 | $810.16 | $1,151.84 |
- 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
- $717.64 / $1,088.41 / $2,120.31
| Professional | | $717.64 | $1,088.41 | $2,120.31 |