- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.73 / $360.73 / $503.87
| Professional | | $360.73 | $360.73 | $503.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.00 / $1,419.00 / $1,986.00
| Professional | | $917.00 | $1,419.00 | $1,986.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.51 / $607.60 / $884.66
| Professional | | $437.51 | $607.60 | $884.66 |
- 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
- $515.75 / $838.20 / $1,512.51
| Professional | | $515.75 | $838.20 | $1,512.51 |