- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.36 / $250.71 / $323.44
| Professional | | $250.36 | $250.71 | $323.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,385.60 / $1,385.60 / $1,385.60
| Facility | | $1,385.60 | $1,385.60 | $1,385.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.00 / $617.00 / $992.00
| Professional | | $514.00 | $617.00 | $992.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.54 / $522.19 / $873.70
| Professional | | $367.54 | $522.19 | $873.70 |
- 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
- $443.71 / $556.16 / $1,643.19
| Professional | | $443.71 | $556.16 | $1,643.19 |