- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.56 / $60.23 / $96.41
| Professional | | $40.56 | $60.23 | $96.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.78 / $66.72 / $120.04
| Professional | | $44.78 | $66.72 | $120.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.32 / $89.30 / $126.44
| Professional | | $60.32 | $89.30 | $126.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.02 / $1,401.00 / $4,915.00
| Facility | | $331.02 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.07 / $87.65 / $141.19
| Professional | | $53.07 | $87.65 | $141.19 |