- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.56 / $121.19 / $215.64
| Professional | | $81.56 | $121.19 | $215.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.00 / $325.00 / $697.00
| Professional | | $210.00 | $325.00 | $697.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.25 / $195.43 / $375.28
| Professional | | $114.25 | $195.43 | $375.28 |
- 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
- $192.94 / $308.02 / $627.01
| Professional | | $192.94 | $308.02 | $627.01 |