- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.51 / $311.66 / $390.86
| Professional | | $223.51 | $311.66 | $390.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.00 / $557.00 / $810.00
| Professional | | $334.00 | $557.00 | $810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.30 / $415.71 / $656.61
| Professional | | $261.30 | $415.71 | $656.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.47 / $643.20 / $1,160.64
| Professional | | $357.47 | $643.20 | $1,160.64 |