- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.13 / $72.51 / $78.58
| Professional | | $54.13 | $72.51 | $78.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.00 / $287.00 / $287.00
| Facility | | $287.00 | $287.00 | $287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $147.00 / $222.00
| Professional | | $104.00 | $147.00 | $222.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $156.00 / $235.50 / $333.00
| Professional | 50 | $156.00 | $235.50 | $333.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.78 / $122.18 / $216.30
| Professional | | $76.78 | $122.18 | $216.30 |
- 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
- $106.32 / $152.69 / $308.10
| Professional | | $106.32 | $152.69 | $308.10 |