- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.96 / $94.08 / $300.47
| Professional | | $39.96 | $94.08 | $300.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.00 / $152.00 / $614.00
| Professional | | $84.00 | $152.00 | $614.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.23 / $130.56 / $394.22
| Professional | | $57.23 | $130.56 | $394.22 |
- 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
- $198.47 / $354.41 / $496.58
| Professional | | $198.47 | $354.41 | $496.58 |