- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.01 / $362.33 / $448.00
| Professional | | $286.01 | $362.33 | $448.00 |
- 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
- $551.00 / $828.00 / $1,253.00
| Professional | | $551.00 | $828.00 | $1,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.75 / $628.70 / $1,219.58
| Professional | | $384.75 | $628.70 | $1,219.58 |
- 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
- $477.28 / $874.85 / $1,388.39
| Professional | | $477.28 | $874.85 | $1,388.39 |