- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.46 / $458.27 / $559.91
| Professional | | $353.46 | $458.27 | $559.91 |
- 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
- $678.00 / $1,006.00 / $1,521.00
| Professional | | $678.00 | $1,006.00 | $1,521.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.62 / $785.16 / $1,484.48
| Professional | | $493.62 | $785.16 | $1,484.48 |
- 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
- $601.54 / $1,078.23 / $1,747.19
| Professional | | $601.54 | $1,078.23 | $1,747.19 |