- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.18 / $153.76 / $242.43
| Professional | | $96.18 | $153.76 | $242.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.16 / $170.99 / $279.55
| Professional | | $105.16 | $170.99 | $279.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.25 / $211.36 / $324.87
| Professional | | $152.25 | $211.36 | $324.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.93 / $225.19 / $350.89
| Professional | | $139.93 | $225.19 | $350.89 |