- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.25 / $136.37 / $172.12
| Professional | | $134.25 | $136.37 | $172.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.00 / $252.00 / $252.00
| Facility | | $252.00 | $252.00 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.00 / $310.00 / $468.00
| Professional | | $258.00 | $310.00 | $468.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.85 / $236.77 / $376.19
| Professional | | $157.85 | $236.77 | $376.19 |
- 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
- $180.32 / $256.32 / $435.48
| Professional | | $180.32 | $256.32 | $435.48 |