- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.31 / $133.74 / $199.91
| Professional | | $96.31 | $133.74 | $199.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.18 / $131.38 / $261.32
| Professional | | $99.18 | $131.38 | $261.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.14 / $210.15 / $264.54
| Professional | | $127.14 | $210.15 | $264.54 |
- 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
- $106.15 / $170.51 / $262.66
| Professional | | $106.15 | $170.51 | $262.66 |