- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $52.48 / $61.66
| Professional | | $50.12 | $52.48 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,698.24
| Facility | | $398.11 | $691.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $100.00 / $100.00
| Professional | | $85.11 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $57.54 / $104.71
| Facility | | $42.66 | $57.54 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $52.48 / $61.66
| Professional | | $50.12 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $2,041.74 / $4,265.80
| Professional | | $61.66 | $2,041.74 | $4,265.80 |