- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $378.73 / $513.47
| Professional | | $40.00 | $378.73 | $513.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.58 / $66.34 / $137.40
| Professional | | $29.58 | $66.34 | $137.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.26 / $112.44 / $128.59
| Professional | | $102.26 | $112.44 | $128.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.94 / $389.33 / $686.94
| Facility | | $240.94 | $389.33 | $686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.97 / $55.63 / $3,919.21
| Professional | | $38.97 | $55.63 | $3,919.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.97 / $53.76 / $425.74
| Professional | | $38.97 | $53.76 | $425.74 |