- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.46 / $183.33 / $185.22
| Professional | | $96.46 | $183.33 | $185.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $202.00 / $321.00
| Professional | | $126.00 | $202.00 | $321.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.59 / $203.61 / $330.40
| Professional | | $125.59 | $203.61 | $330.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.84 / $316.20 / $514.80
| Professional | | $147.84 | $316.20 | $514.80 |