- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $562.34
| Professional | | $190.55 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $371.54 / $645.65
| Professional | | $190.55 | $371.54 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $691.83
| Facility | | $338.84 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $380.19 / $776.25
| Professional | | $204.17 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $1,000.00
| Professional | | $234.42 | $478.63 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $363.08 / $831.76
| Professional | | $194.98 | $363.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $741.31
| Professional | | $208.93 | $363.08 | $741.31 |