- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.45 / $119.09 / $159.82
| Professional | | $93.45 | $119.09 | $159.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.00 / $287.00 / $287.00
| Facility | | $287.00 | $287.00 | $287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.00 / $242.00 / $366.00
| Professional | | $180.00 | $242.00 | $366.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $207.34 / $354.16
| Professional | | $130.66 | $207.34 | $354.16 |
- 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
- $133.01 / $244.47 / $380.01
| Professional | | $133.01 | $244.47 | $380.01 |