- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.06 / $25.45 / $29.71
| Professional | | $23.06 | $25.45 | $29.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.03 / $236.63 / $331.77
| Professional | | $25.03 | $236.63 | $331.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.14 / $46.29 / $86.85
| Professional | | $28.14 | $46.29 | $86.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,360.00 / $3,360.00 / $7,448.00
| Facility | | $3,360.00 | $3,360.00 | $7,448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.58 / $40.69 / $75.62
| Professional | | $28.58 | $40.69 | $75.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $2,750.00 / $3,500.00
| Professional | | $2,500.00 | $2,750.00 | $3,500.00 |