- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.69 / $153.12 / $225.01
| Professional | | $149.69 | $153.12 | $225.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.00 / $523.00 / $810.00
| Professional | | $436.00 | $523.00 | $810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.88 / $276.18 / $397.57
| Professional | | $173.88 | $276.18 | $397.57 |
- 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
- $182.38 / $315.01 / $648.10
| Professional | | $182.38 | $315.01 | $648.10 |