- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.61 / $279.69 / $367.53
| Professional | | $170.61 | $279.69 | $367.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.00 / $816.00 / $1,434.00
| Professional | | $528.00 | $816.00 | $1,434.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.22 / $382.60 / $738.09
| Professional | | $224.22 | $382.60 | $738.09 |
- 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
- $355.51 / $626.20 / $1,127.28
| Professional | | $355.51 | $626.20 | $1,127.28 |