- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.52 / $223.83 / $301.58
| Professional | | $157.52 | $223.83 | $301.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.00 / $611.00 / $945.00
| Professional | | $436.00 | $611.00 | $945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.49 / $307.91 / $527.86
| Professional | | $196.49 | $307.91 | $527.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.14 / $429.28 / $910.80
| Professional | | $245.14 | $429.28 | $910.80 |