- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $107.15 / $251.19
| Professional | | $87.10 | $107.15 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $501.19
| Professional | | $302.00 | $489.78 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $478.63 / $741.31
| Professional | 50 | $295.12 | $478.63 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $141.25 / $194.98
| Professional | | $102.33 | $141.25 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $295.12 / $3,090.30
| Facility | | $257.04 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $346.74
| Professional | | $117.49 | $194.98 | $346.74 |