- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.81 / $97.91 / $106.85
| Professional | | $77.81 | $97.91 | $106.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.47 / $761.66 / $1,013.32
| Facility | | $614.47 | $761.66 | $1,013.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.90 / $122.90 / $206.35
| Professional | | $122.90 | $122.90 | $206.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.94 / $1,302.17 / $2,289.13
| Facility | | $422.94 | $1,302.17 | $2,289.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.61 / $172.73 / $230.44
| Professional | | $89.61 | $172.73 | $230.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.89 / $124.07 / $191.63
| Professional | | $94.89 | $124.07 | $191.63 |