- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.11 / $96.51 / $177.52
| Professional | | $55.11 | $96.51 | $177.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.00 / $156.00 / $222.00
| Professional | | $97.00 | $156.00 | $222.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.81 / $105.65 / $168.08
| Professional | | $69.81 | $105.65 | $168.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.98 / $161.40 / $302.50
| Professional | | $112.98 | $161.40 | $302.50 |