- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.67 / $167.20 / $222.27
| Professional | | $107.67 | $167.20 | $222.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.00 / $447.00 / $761.00
| Professional | | $289.00 | $447.00 | $761.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.19 / $230.40 / $399.83
| Professional | | $138.19 | $230.40 | $399.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $5,606.00 / $6,486.14
| Facility | | $1,275.00 | $5,606.00 | $6,486.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.74 / $351.74 / $675.83
| Professional | | $188.74 | $351.74 | $675.83 |