- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.74 / $256.74 / $363.33
| Professional | | $256.74 | $256.74 | $363.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.00 / $700.00 / $907.00
| Professional | | $583.00 | $700.00 | $907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.52 / $464.98 / $827.24
| Professional | | $355.52 | $464.98 | $827.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.85 / $896.41 / $1,434.84
| Professional | | $531.85 | $896.41 | $1,434.84 |