- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.16 / $159.79 / $643.24
| Professional | | $108.16 | $159.79 | $643.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $467.00 / $1,971.00
| Professional | | $302.00 | $467.00 | $1,971.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.04 / $288.00 / $1,262.35
| Professional | | $161.04 | $288.00 | $1,262.35 |
- 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
- $247.50 / $645.46 / $1,627.29
| Professional | | $247.50 | $645.46 | $1,627.29 |