- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.73 / $142.15 / $158.13
| Professional | | $107.73 | $142.15 | $158.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.00 / $379.00 / $587.00
| Professional | | $272.00 | $379.00 | $587.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.11 / $219.49 / $379.56
| Professional | | $132.11 | $219.49 | $379.56 |
- 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
- $169.18 / $305.24 / $637.54
| Professional | | $169.18 | $305.24 | $637.54 |