- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.07 / $528.01 / $798.86
| Professional | | $450.07 | $528.01 | $798.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,800.00 / $2,785.00
| Professional | | $1,500.00 | $1,800.00 | $2,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.29 / $877.35 / $1,248.31
| Professional | | $583.29 | $877.35 | $1,248.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.54 / $1,035.61 / $1,962.84
| Professional | | $575.54 | $1,035.61 | $1,962.84 |