- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.10 / $135.43 / $209.30
| Professional | | $124.10 | $135.43 | $209.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.00 / $415.00 / $643.00
| Professional | | $346.00 | $415.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.69 / $268.11 / $323.39
| Professional | | $184.69 | $268.11 | $323.39 |
- 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
- $163.80 / $271.64 / $867.25
| Professional | | $163.80 | $271.64 | $867.25 |