- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.00 / $164.22 / $235.48
| Professional | | $146.00 | $164.22 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.00 / $487.00 / $754.00
| Professional | | $406.00 | $487.00 | $754.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.61 / $263.02 / $378.51
| Professional | | $163.61 | $263.02 | $378.51 |
- 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
- $181.42 / $318.31 / $617.51
| Professional | | $181.42 | $318.31 | $617.51 |