- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.34 / $596.77 / $868.80
| Professional | | $588.34 | $596.77 | $868.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.00 / $2,004.00 / $3,101.00
| Professional | | $1,670.00 | $2,004.00 | $3,101.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.95 / $1,080.93 / $1,453.29
| Professional | | $640.95 | $1,080.93 | $1,453.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.93 / $1,141.46 / $2,485.57
| Professional | | $684.93 | $1,141.46 | $2,485.57 |