- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.31 / $126.70 / $723.61
| Professional | | $60.31 | $126.70 | $723.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.00 / $266.00 / $2,579.00
| Professional | | $172.00 | $266.00 | $2,579.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.79 / $283.83 / $1,426.72
| Professional | | $84.79 | $283.83 | $1,426.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.04 / $1,322.71 / $2,056.02
| Professional | | $567.04 | $1,322.71 | $2,056.02 |