- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.08 / $241.33 / $481.13
| Professional | | $153.08 | $241.33 | $481.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $2,922.50
| Facility | | $55.00 | $55.00 | $2,922.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.00 / $1,397.77 / $1,397.77
| Professional | | $816.00 | $1,397.77 | $1,397.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.15 / $109.82 / $185.79
| Facility | | $54.15 | $109.82 | $185.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $191.70 / $465.20
| Professional | | $5.00 | $191.70 | $465.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.15 / $114.38 / $186.35
| Facility | | $54.15 | $114.38 | $186.35 |