- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.70 / $175.71 / $475.32
| Professional | | $113.70 | $175.71 | $475.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.59 / $168.49 / $234.19
| Professional | | $114.59 | $168.49 | $234.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.83 / $158.83 / $699.00
| Facility | | $158.83 | $158.83 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.98 / $200.60 / $336.55
| Professional | | $120.98 | $200.60 | $336.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.83 / $183.84 / $326.30
| Professional | | $115.83 | $183.84 | $326.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.70 / $173.51 / $475.32
| Professional | | $113.70 | $173.51 | $475.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.13 / $197.55 / $302.63
| Professional | | $138.13 | $197.55 | $302.63 |