- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.39 / $141.13 / $770.06
| Professional | | $84.39 | $141.13 | $770.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.81 / $138.81 / $138.81
| Facility | | $138.81 | $138.81 | $138.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.61 / $160.05 / $353.00
| Professional | | $94.61 | $160.05 | $353.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.22 / $139.30 / $301.41
| Facility | | $86.22 | $139.30 | $301.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.93 / $220.33 / $376.47
| Professional | | $124.93 | $220.33 | $376.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.24 / $244.85 / $304.83
| Professional | | $203.24 | $244.85 | $304.83 |