- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.15 / $155.32 / $261.88
| Professional | | $131.15 | $155.32 | $261.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.00 / $405.00 / $858.00
| Professional | | $277.00 | $405.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.91 / $314.63 / $612.04
| Professional | | $169.91 | $314.63 | $612.04 |
- 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
- $369.61 / $654.03 / $1,081.08
| Professional | | $369.61 | $654.03 | $1,081.08 |