- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.38 / $413.80 / $495.78
| Professional | | $390.38 | $413.80 | $495.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,509.35 / $6,509.35 / $6,509.35
| Facility | | $6,509.35 | $6,509.35 | $6,509.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.31 / $1,500.31 / $1,500.31
| Professional | | $1,500.31 | $1,500.31 | $1,500.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.54 / $546.97 / $844.25
| Professional | | $513.54 | $546.97 | $844.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.10 / $261.50 / $473.40
| Professional | | $251.10 | $261.50 | $473.40 |