- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.16 / $133.35 / $211.71
| Professional | | $105.16 | $133.35 | $211.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $739.00 / $739.00
| Facility | | $739.00 | $739.00 | $739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.00 / $327.00 / $526.00
| Professional | | $217.00 | $327.00 | $526.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $325.50 / $525.00 / $789.00
| Professional | 50 | $325.50 | $525.00 | $789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.80 / $254.88 / $415.30
| Professional | | $156.80 | $254.88 | $415.30 |
- 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
- $226.86 / $325.83 / $701.99
| Professional | | $226.86 | $325.83 | $701.99 |