- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.48 / $268.57 / $593.29
| Professional | | $168.48 | $268.57 | $593.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.00 / $726.00 / $2,227.00
| Professional | | $469.00 | $726.00 | $2,227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.73 / $581.61 / $1,237.24
| Professional | | $265.73 | $581.61 | $1,237.24 |
- 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
- $555.84 / $1,108.19 / $2,292.83
| Professional | | $555.84 | $1,108.19 | $2,292.83 |