- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $954.99 / $1,288.25
| Professional | | $28.18 | $954.99 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $31.62 / $38.02
| Professional | | $28.84 | $31.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Professional | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,584.89 / $1,737.80
| Professional | | $1,318.26 | $1,584.89 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $912.01 / $7,943.28
| Facility | | $19.50 | $912.01 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $831.76 / $2,041.74
| Professional | | $21.38 | $831.76 | $2,041.74 |