- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $194.98 / $398.11
| Professional | | $104.71 | $194.98 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $870.96
| Professional | | $295.12 | $549.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $229.09 / $446.68
| Professional | | $123.03 | $229.09 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $5,370.32
| Facility | | $1,000.00 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $239.88 / $478.63
| Professional | | $134.90 | $239.88 | $478.63 |