- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.38 / $126.58 / $166.52
| Professional | | $116.38 | $126.58 | $166.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.00 / $263.00 / $316.00
| Professional | | $263.00 | $263.00 | $316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.02 / $209.96 / $317.43
| Professional | | $184.02 | $209.96 | $317.43 |
- 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
- $156.91 / $268.14 / $452.11
| Professional | | $156.91 | $268.14 | $452.11 |