- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.08 / $617.35 / $929.31
| Professional | | $561.08 | $617.35 | $929.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,106.00 / $3,258.00
| Professional | | $1,755.00 | $2,106.00 | $3,258.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.20 / $1,044.32 / $1,467.66
| Professional | | $683.20 | $1,044.32 | $1,467.66 |
- 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
- $693.20 / $1,218.79 / $2,099.51
| Professional | | $693.20 | $1,218.79 | $2,099.51 |