- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.78 / $500.78 / $500.78
| Professional | | $500.78 | $500.78 | $500.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.00 / $1,115.00 / $1,673.00
| Professional | | $929.00 | $1,115.00 | $1,673.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.10 / $791.02 / $1,052.57
| Professional | | $591.10 | $791.02 | $1,052.57 |
- 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
- $666.60 / $1,059.13 / $1,743.73
| Professional | | $666.60 | $1,059.13 | $1,743.73 |