- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.34 / $298.64 / $498.91
| Professional | | $239.34 | $298.64 | $498.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.20 / $2,767.20 / $2,767.20
| Facility | | $2,767.20 | $2,767.20 | $2,767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.00 / $685.00 / $1,062.00
| Professional | | $453.00 | $685.00 | $1,062.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.36 / $522.29 / $1,004.75
| Professional | | $318.36 | $522.29 | $1,004.75 |
- 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
- $527.23 / $757.22 / $1,253.18
| Professional | | $527.23 | $757.22 | $1,253.18 |