- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.81 / $124.32 / $222.38
| Professional | | $85.81 | $124.32 | $222.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.00 / $361.00 / $850.00
| Professional | | $233.00 | $361.00 | $850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.30 / $211.32 / $398.32
| Professional | | $121.30 | $211.32 | $398.32 |
- 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
- $209.60 / $378.22 / $677.31
| Professional | | $209.60 | $378.22 | $677.31 |