- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $371.54
| Facility | | $302.00 | $346.74 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $489.78
| Professional | | $30.20 | $47.86 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $407.38
| Professional | | $162.18 | $257.04 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,398.83 / $2,398.83
| Professional | | $1,122.02 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $54.95 / $85.11
| Professional | | $39.81 | $54.95 | $85.11 |