- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.54 / $126.57 / $176.92
| Professional | | $102.54 | $126.57 | $176.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.00 / $316.00 / $316.00
| Facility | | $316.00 | $316.00 | $316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.00 / $293.00 / $472.00
| Professional | | $213.00 | $293.00 | $472.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $319.50 / $514.50 / $708.00
| Professional | 50 | $319.50 | $514.50 | $708.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.26 / $210.06 / $368.82
| Professional | | $117.26 | $210.06 | $368.82 |
- 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
- $117.48 / $252.14 / $391.92
| Professional | | $117.48 | $252.14 | $391.92 |