- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.93 / $153.47 / $182.99
| Professional | | $103.93 | $153.47 | $182.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.00 / $438.00 / $712.00
| Professional | | $283.00 | $438.00 | $712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.09 / $224.64 / $383.84
| Professional | | $130.09 | $224.64 | $383.84 |
- 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
- $176.42 / $314.97 / $648.10
| Professional | | $176.42 | $314.97 | $648.10 |