- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.94 / $100.75 / $131.12
| Professional | | $91.94 | $100.75 | $131.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.76 / $119.15 / $129.82
| Facility | | $108.76 | $119.15 | $129.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.14 / $109.22 / $115.39
| Professional | | $59.14 | $109.22 | $115.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.35 / $116.35 / $1,863.00
| Facility | | $116.35 | $116.35 | $1,863.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.15 / $121.92 / $219.05
| Professional | | $86.15 | $121.92 | $219.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.47 / $105.33 / $166.85
| Professional | | $77.47 | $105.33 | $166.85 |