- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.53 / $90.77 / $341.00
| Professional | | $40.53 | $90.77 | $341.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.08 / $541.08 / $653.65
| Facility | | $541.08 | $541.08 | $653.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.32 / $150.71 / $440.51
| Professional | | $123.32 | $150.71 | $440.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.58 / $125.54 / $440.51
| Professional | | $56.58 | $125.54 | $440.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.95 / $131.26 / $440.51
| Professional | | $67.95 | $131.26 | $440.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.80 / $147.57 / $540.67
| Professional | | $100.80 | $147.57 | $540.67 |