- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.03 / $328.03 / $478.22
| Professional | | $328.03 | $328.03 | $478.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.00 / $907.00 / $1,163.00
| Professional | | $756.00 | $907.00 | $1,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.96 / $620.13 / $1,059.83
| Professional | | $373.96 | $620.13 | $1,059.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.89 / $1,207.79 / $1,756.92
| Professional | | $603.89 | $1,207.79 | $1,756.92 |