- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.64 / $103.15 / $149.65
| Professional | | $102.64 | $103.15 | $149.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.00 / $258.00 / $343.00
| Professional | | $180.00 | $258.00 | $343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.81 / $161.19 / $232.57
| Professional | | $120.81 | $161.19 | $232.57 |
- 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
- $154.16 / $247.80 / $447.15
| Professional | | $154.16 | $247.80 | $447.15 |