- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.21 / $147.49 / $439.48
| Professional | | $57.21 | $147.49 | $439.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.00 / $192.00 / $780.00
| Professional | | $128.00 | $192.00 | $780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.26 / $194.41 / $472.35
| Professional | | $90.26 | $194.41 | $472.35 |
- 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
- $265.62 / $466.48 / $608.51
| Professional | | $265.62 | $466.48 | $608.51 |