- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.78 / $301.39 / $429.01
| Professional | | $204.78 | $301.39 | $429.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.00 / $922.00 / $1,427.00
| Professional | | $598.00 | $922.00 | $1,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.02 / $443.71 / $767.48
| Professional | | $261.02 | $443.71 | $767.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.85 / $689.57 / $1,256.65
| Professional | | $353.85 | $689.57 | $1,256.65 |