- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.14 / $85.80 / $140.63
| Professional | | $53.14 | $85.80 | $140.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.00 / $212.00 / $385.00
| Professional | | $137.00 | $212.00 | $385.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.16 / $128.76 / $227.92
| Professional | | $72.16 | $128.76 | $227.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.88 / $194.56 / $426.35
| Professional | | $116.88 | $194.56 | $426.35 |