- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.31 / $38.19 / $57.42
| Professional | | $32.31 | $38.19 | $57.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.00 / $152.00 / $181.00
| Professional | | $94.00 | $152.00 | $181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $52.00 / $76.00
| Professional | | $40.00 | $52.00 | $76.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.58 / $77.31 / $144.30
| Professional | | $52.58 | $77.31 | $144.30 |