- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $173.78 / $363.08
| Professional | | $134.90 | $173.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $851.14
| Facility | | $354.81 | $676.08 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $134.90 / $218.78
| Professional | | $102.33 | $134.90 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $239.88 / $346.74
| Professional | | $100.00 | $239.88 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $158.49 / $295.12
| Professional | | $75.86 | $158.49 | $295.12 |