- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.22 / $114.87 / $176.12
| Professional | | $56.22 | $114.87 | $176.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.00 / $187.00 / $316.00
| Professional | | $125.00 | $187.00 | $316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.57 / $142.41 / $252.67
| Professional | | $87.57 | $142.41 | $252.67 |
- 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
- $140.53 / $238.91 / $371.37
| Professional | | $140.53 | $238.91 | $371.37 |