- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.45 / $1,268.00 / $2,250.00
| Facility | | $52.45 | $1,268.00 | $2,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.45 / $52.45 / $58.98
| Professional | | $47.45 | $52.45 | $58.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,569.65 / $6,759.03 / $9,093.06
| Facility | | $5,569.65 | $6,759.03 | $9,093.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.00 / $3,816.00 / $7,227.00
| Facility | | $1,074.00 | $3,816.00 | $7,227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.33 / $53.60 / $77.42
| Professional | | $32.33 | $53.60 | $77.42 |