- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.65 / $275.41 / $378.84
| Professional | | $57.65 | $275.41 | $378.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $194.00 / $16,394.00
| Facility | | $194.00 | $194.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.32 / $257.89 / $687.43
| Professional | | $151.32 | $257.89 | $687.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.06 / $194.00 / $199.67
| Facility | | $154.06 | $194.00 | $199.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.24 / $199.67 / $278.64
| Professional | | $53.24 | $199.67 | $278.64 |