- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.21 / $108.73 / $128.52
| Professional | | $82.21 | $108.73 | $128.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.00 / $193.00 / $268.00
| Professional | | $124.00 | $193.00 | $268.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.73 / $157.08 / $239.67
| Professional | | $98.73 | $157.08 | $239.67 |
- 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
- $130.07 / $224.41 / $401.71
| Professional | | $130.07 | $224.41 | $401.71 |