- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.35 / $732.13 / $927.12
| Professional | | $492.35 | $732.13 | $927.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.22 / $123.78 / $238.23
| Facility | | $38.22 | $123.78 | $238.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.76 / $4,077.00 / $5,096.25
| Professional | | $71.76 | $4,077.00 | $5,096.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.58 / $617.45 / $1,004.88
| Facility | | $95.58 | $617.45 | $1,004.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.94 / $101.42 / $199.28
| Professional | | $48.94 | $101.42 | $199.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.94 / $77.62 / $199.28
| Professional | | $48.94 | $77.62 | $199.28 |