- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $114.82 / $158.49
| Professional | | $77.62 | $114.82 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $112.20 / $17,782.79
| Facility | | $0.02 | $112.20 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $213.80 / $251.19
| Professional | | $190.55 | $213.80 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $177.83 / $346.74
| Professional | | $109.65 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $144.54 / $208.93
| Professional | | $120.23 | $144.54 | $208.93 |