- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $154.88 / $457.09
| Professional | | $114.82 | $154.88 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $239.88 / $436.52
| Professional | | $213.80 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $162.18 / $446.68
| Professional | | $120.23 | $162.18 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $131.83 / $281.84
| Professional | | $117.49 | $131.83 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $2,884.03 / $3,311.31
| Facility | | $112.20 | $2,884.03 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $331.13
| Professional | | $109.65 | $151.36 | $331.13 |