- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.15 / $262.73 / $358.08
| Professional | | $217.15 | $262.73 | $358.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.96 / $1,038.96 / $1,038.96
| Professional | | $1,038.96 | $1,038.96 | $1,038.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $417.07
| Facility | | $64.00 | $64.00 | $417.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.57 / $61.57 / $61.57
| Professional | | $61.57 | $61.57 | $61.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.71 / $26.98 / $49.30
| Professional | | $23.71 | $26.98 | $49.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.63 / $51.63 / $300.39
| Professional | | $51.63 | $51.63 | $300.39 |