- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.05 / $190.40 / $228.55
| Professional | | $149.05 | $190.40 | $228.55 |
- 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
- $285.00 / $420.00 / $636.00
| Professional | | $285.00 | $420.00 | $636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.54 / $324.39 / $620.26
| Professional | | $198.54 | $324.39 | $620.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.89 / $420.01 / $652.86
| Professional | | $293.89 | $420.01 | $652.86 |