- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.42 / $104.42 / $132.38
| Professional | | $96.42 | $104.42 | $132.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.57 / $732.61 / $814.01
| Facility | | $231.57 | $732.61 | $814.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.43 / $115.47 / $120.53
| Professional | | $83.43 | $115.47 | $120.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.08 / $1,100.00 / $1,863.00
| Facility | | $465.08 | $1,100.00 | $1,863.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.88 / $152.19 / $277.67
| Professional | | $103.88 | $152.19 | $277.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.74 / $128.50 / $176.45
| Professional | | $93.74 | $128.50 | $176.45 |