- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.04 / $169.30 / $227.28
| Professional | | $121.04 | $169.30 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.00 / $493.00 / $891.00
| Professional | | $318.00 | $493.00 | $891.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.16 / $254.51 / $497.54
| Professional | | $157.16 | $254.51 | $497.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.46 / $392.31 / $826.34
| Professional | | $222.46 | $392.31 | $826.34 |