- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.41 / $156.50 / $236.57
| Professional | | $153.41 | $156.50 | $236.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.00 / $305.00 / $407.00
| Professional | | $198.00 | $305.00 | $407.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.32 / $273.17 / $410.19
| Professional | | $187.32 | $273.17 | $410.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.86 / $393.01 / $709.17
| Professional | | $227.86 | $393.01 | $709.17 |