- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $85.11 / $269.15
| Professional | | $57.54 | $85.11 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $407.38
| Facility | | $257.04 | $354.81 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $186.21
| Professional | | $74.13 | $100.00 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $107.15
| Facility | | $102.33 | $102.33 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $107.15
| Professional | | $77.62 | $77.62 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $81.28 / $181.97
| Facility | | $66.07 | $81.28 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $95.50 / $147.91
| Professional | | $66.07 | $95.50 | $147.91 |