- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.62 / $386.53 / $2,439.88
| Professional | | $322.62 | $386.53 | $2,439.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.00 / $170.00 / $178.00
| Professional | | $170.00 | $170.00 | $178.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.58 / $548.65 / $1,356.93
| Facility | | $191.58 | $548.65 | $1,356.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.33 / $188.33 / $188.33
| Professional | | $188.33 | $188.33 | $188.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.96 / $901.80 / $1,026.80
| Facility | | $143.96 | $901.80 | $1,026.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.58 / $548.65 / $1,356.93
| Facility | | $191.58 | $548.65 | $1,356.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.33 / $188.33 / $188.33
| Professional | | $188.33 | $188.33 | $188.33 |