- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.07 / $338.07 / $443.62
| Professional | | $338.07 | $338.07 | $443.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.00 / $1,613.00 / $2,077.00
| Professional | | $998.00 | $1,613.00 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.66 / $520.85 / $761.25
| Professional | | $400.66 | $520.85 | $761.25 |
- 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
- $401.23 / $908.61 / $1,267.83
| Professional | | $401.23 | $908.61 | $1,267.83 |