- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.48 / $106.96 / $116.24
| Professional | | $103.48 | $106.96 | $116.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.70 / $76.70 / $76.70
| Professional | | $76.70 | $76.70 | $76.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.70 / $83.32 / $152.60
| Facility | | $68.70 | $83.32 | $152.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.70 / $76.70 / $10,000.00
| Professional | | $76.70 | $76.70 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.91 / $161.82 / $178.56
| Professional | | $133.91 | $161.82 | $178.56 |