- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.00 / $161.88 / $523.25
| Professional | | $127.00 | $161.88 | $523.25 |
- 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
- $243.00 / $368.00 / $1,093.00
| Professional | | $243.00 | $368.00 | $1,093.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.02 / $536.01 / $1,196.67
| Professional | | $149.02 | $536.01 | $1,196.67 |
- 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
- $667.52 / $838.87 / $2,128.10
| Professional | | $667.52 | $838.87 | $2,128.10 |