- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.44 / $344.13 / $422.09
| Professional | | $269.44 | $344.13 | $422.09 |
- 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
- $524.00 / $787.00 / $1,190.00
| Professional | | $524.00 | $787.00 | $1,190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.72 / $587.52 / $1,153.65
| Professional | | $356.72 | $587.52 | $1,153.65 |
- 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
- $448.40 / $822.60 / $1,294.78
| Professional | | $448.40 | $822.60 | $1,294.78 |