- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $912.01
| Professional | | $724.44 | $724.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $977.24
| Professional | | $151.36 | $151.36 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $691.83 / $1,445.44
| Facility | | $660.69 | $691.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $741.31 / $5,495.41
| Professional | | $660.69 | $741.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Professional | | $707.95 | $707.95 | $707.95 |