- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.52 / $296.63 / $390.05
| Professional | | $202.52 | $296.63 | $390.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.00 / $889.00 / $1,528.00
| Professional | | $574.00 | $889.00 | $1,528.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.22 / $422.66 / $734.78
| Professional | | $261.22 | $422.66 | $734.78 |
- 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
- $343.70 / $608.84 / $1,260.59
| Professional | | $343.70 | $608.84 | $1,260.59 |