- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.71 / $116.28 / $157.15
| Professional | | $105.71 | $116.28 | $157.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $365.00 / $564.00
| Professional | | $304.00 | $365.00 | $564.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.11 / $193.22 / $267.52
| Professional | | $120.11 | $193.22 | $267.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $11,905.62 / $14,634.00
| Facility | | $4,200.00 | $11,905.62 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.85 / $237.53 / $476.54
| Professional | | $128.85 | $237.53 | $476.54 |