- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $162.63 / $225.88
| Professional | | $156.22 | $162.63 | $225.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.84 / $91.84 / $91.84
| Professional | | $91.84 | $91.84 | $91.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.13 / $225.88 / $271.06
| Facility | | $154.13 | $225.88 | $271.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.77 / $225.44 / $237.31
| Professional | | $181.77 | $225.44 | $237.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.13 / $225.88 / $271.06
| Facility | | $154.13 | $225.88 | $271.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.84 / $224.23 / $10,000.00
| Professional | | $91.84 | $224.23 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.10 / $118.40 / $424.81
| Professional | | $83.10 | $118.40 | $424.81 |