- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.06 / $417.51 / $622.77
| Professional | | $413.06 | $417.51 | $622.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.00 / $1,432.00 / $2,215.00
| Professional | | $1,193.00 | $1,432.00 | $2,215.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.36 / $758.86 / $1,082.04
| Professional | | $476.36 | $758.86 | $1,082.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.37 / $846.76 / $1,725.23
| Professional | | $489.37 | $846.76 | $1,725.23 |