- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $794.33 / $1,258.93
| Professional | | $776.25 | $794.33 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,000.00
| Professional | | $851.14 | $851.14 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $478.63 / $912.01
| Facility | | $47.86 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $831.76
| Professional | | $436.52 | $691.83 | $831.76 |