- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.47 / $446.73 / $574.38
| Professional | | $411.47 | $446.73 | $574.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.60 / $1,373.60 / $1,373.60
| Facility | | $1,373.60 | $1,373.60 | $1,373.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.00 / $863.00 / $1,305.00
| Professional | | $785.00 | $863.00 | $1,305.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.22 / $812.48 / $1,262.25
| Professional | | $532.22 | $812.48 | $1,262.25 |
- 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
- $606.62 / $862.30 / $1,352.00
| Professional | | $606.62 | $862.30 | $1,352.00 |