- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.73 / $112.38 / $235.54
| Professional | | $72.73 | $112.38 | $235.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.00 / $197.00 / $262.00
| Professional | | $128.00 | $197.00 | $262.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.33 / $181.23 / $288.32
| Professional | | $116.33 | $181.23 | $288.32 |
- 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
- $141.12 / $204.96 / $435.61
| Professional | | $141.12 | $204.96 | $435.61 |