- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.41 / $180.41 / $551.04
| Professional | | $180.41 | $180.41 | $551.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.00 / $477.00 / $1,389.00
| Professional | | $327.00 | $477.00 | $1,389.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.54 / $422.44 / $1,144.33
| Professional | | $246.54 | $422.44 | $1,144.33 |
- 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
- $778.25 / $1,174.46 / $1,867.79
| Professional | | $778.25 | $1,174.46 | $1,867.79 |