- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.80 / $410.30 / $483.81
| Professional | | $310.80 | $410.30 | $483.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Professional | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.93 / $1,339.93 / $1,339.93
| Facility | | $1,339.93 | $1,339.93 | $1,339.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.55 / $182.55 / $228.18
| Professional | | $182.55 | $182.55 | $228.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,237.46 / $3,237.46 / $3,237.46
| Professional | | $3,237.46 | $3,237.46 | $3,237.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.80 / $471.84 / $483.81
| Professional | | $310.80 | $471.84 | $483.81 |