- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.73 / $134.66 / $225.51
| Professional | | $91.73 | $134.66 | $225.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.00 / $404.00 / $861.00
| Professional | | $261.00 | $404.00 | $861.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.72 / $229.69 / $410.74
| Professional | | $130.72 | $229.69 | $410.74 |
- 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
- $213.76 / $371.25 / $677.31
| Professional | | $213.76 | $371.25 | $677.31 |