- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.54 / $41.11 / $228.71
| Professional | | $40.54 | $41.11 | $228.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.58 / $481.92 / $851.93
| Professional | | $71.58 | $481.92 | $851.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.32 / $438.63 / $654.60
| Professional | | $122.32 | $438.63 | $654.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.83 / $422.43 / $829.77
| Professional | | $268.83 | $422.43 | $829.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.62 / $63.75 / $483.56
| Professional | | $42.62 | $63.75 | $483.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $3,000.00 / $4,410.00
| Professional | | $2,500.00 | $3,000.00 | $4,410.00 |