- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.26 / $165.90 / $243.61
| Professional | | $125.26 | $165.90 | $243.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.00 / $516.00 / $840.00
| Professional | | $333.00 | $516.00 | $840.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.57 / $238.60 / $466.21
| Professional | | $147.57 | $238.60 | $466.21 |
- 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
- $208.38 / $357.13 / $683.74
| Professional | | $208.38 | $357.13 | $683.74 |