- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.42 / $50.83 / $101.66
| Professional | | $25.42 | $50.83 | $101.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $149.00 / $310.00
| Professional | | $75.00 | $149.00 | $310.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.73 / $114.30 / $231.39
| Professional | | $64.73 | $114.30 | $231.39 |
- 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
- $147.94 / $302.07 / $398.63
| Professional | | $147.94 | $302.07 | $398.63 |