- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.77 / $123.51 / $134.26
| Professional | | $75.77 | $123.51 | $134.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.00 / $368.00 / $565.00
| Professional | | $206.00 | $368.00 | $565.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.14 / $186.81 / $297.19
| Professional | | $116.14 | $186.81 | $297.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.72 / $288.00 / $430.30
| Professional | | $133.72 | $288.00 | $430.30 |