- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.65 / $203.08 / $267.87
| Professional | | $178.65 | $203.08 | $267.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.00 / $618.00 / $955.00
| Professional | | $515.00 | $618.00 | $955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.56 / $334.44 / $439.00
| Professional | | $201.56 | $334.44 | $439.00 |
- 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
- $183.36 / $323.99 / $648.71
| Professional | | $183.36 | $323.99 | $648.71 |