- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $208.93
| Professional | | $32.36 | $47.86 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $1,096.48
| Facility | | $891.25 | $1,023.29 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $302.00
| Professional | | $89.13 | $89.13 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $72.44 / $251.19
| Professional | | $53.70 | $72.44 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $302.00
| Professional | | $56.23 | $56.23 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $81.28 / $281.84
| Professional | | $34.67 | $81.28 | $281.84 |