- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.21 / $111.33 / $279.06
| Professional | | $37.21 | $111.33 | $279.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.00 / $175.00 / $718.00
| Professional | | $95.00 | $175.00 | $718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.31 / $125.89 / $340.60
| Professional | | $52.31 | $125.89 | $340.60 |
- 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
- $183.60 / $303.58 / $518.61
| Professional | | $183.60 | $303.58 | $518.61 |