- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.53 / $184.04 / $717.60
| Professional | | $113.53 | $184.04 | $717.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.00 / $234.00 / $317.00
| Professional | | $146.00 | $234.00 | $317.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.13 / $210.61 / $311.35
| Professional | | $145.13 | $210.61 | $311.35 |
- 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
- $174.18 / $300.60 / $542.42
| Professional | | $174.18 | $300.60 | $542.42 |