- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.39 / $408.39 / $468.61
| Professional | | $408.39 | $408.39 | $468.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.00 / $1,949.00 / $2,225.00
| Professional | | $1,205.00 | $1,949.00 | $2,225.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.65 / $627.44 / $917.03
| Professional | | $482.65 | $627.44 | $917.03 |
- 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
- $479.38 / $1,015.68 / $1,488.48
| Professional | | $479.38 | $1,015.68 | $1,488.48 |