- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.37 / $340.37 / $540.34
| Professional | | $340.37 | $340.37 | $540.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.00 / $708.00 / $944.00
| Professional | | $445.00 | $708.00 | $944.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.66 / $597.64 / $888.60
| Professional | | $375.66 | $597.64 | $888.60 |
- 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
- $502.55 / $887.41 / $1,565.20
| Professional | | $502.55 | $887.41 | $1,565.20 |