- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $195.18 / $195.18
| Professional | | $110.00 | $195.18 | $195.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.91 / $161.38 / $634.67
| Facility | | $139.91 | $161.38 | $634.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.94 / $118.94 / $148.68
| Professional | | $118.94 | $118.94 | $148.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.18 / $195.18 / $249.83
| Facility | | $195.18 | $195.18 | $249.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78.00
| Professional | | $55.00 | $55.00 | $78.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.89 / $429.29 / $524.42
| Facility | | $307.89 | $429.29 | $524.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.60 / $471.60 / $471.60
| Professional | | $471.60 | $471.60 | $471.60 |