- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.60 / $192.19 / $270.52
| Professional | | $184.60 | $192.19 | $270.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.53 / $108.53 / $108.53
| Professional | | $108.53 | $108.53 | $108.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.13 / $270.52 / $324.64
| Facility | | $182.13 | $270.52 | $324.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.80 / $270.01 / $284.22
| Professional | | $214.80 | $270.01 | $284.22 |
- 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
- $182.13 / $270.52 / $324.64
| Facility | | $182.13 | $270.52 | $324.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.53 / $264.95 / $10,000.00
| Professional | | $108.53 | $264.95 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.29 / $141.80 / $501.97
| Professional | | $104.29 | $141.80 | $501.97 |