- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.30 / $540.02 / $1,097.17
| Professional | | $328.30 | $540.02 | $1,097.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $1,300.00
| Facility | | $55.00 | $55.00 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,608.00 / $1,633.00 / $1,633.00
| Professional | | $1,608.00 | $1,633.00 | $1,633.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.11 / $280.97 / $410.51
| Facility | | $198.11 | $280.97 | $410.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.70 / $232.70 / $232.70
| Professional | | $232.70 | $232.70 | $232.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.11 / $280.97 / $410.51
| Facility | | $198.11 | $280.97 | $410.51 |