- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.09 / $170.82 / $247.04
| Professional | | $152.09 | $170.82 | $247.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.00 / $568.00 / $878.00
| Professional | | $473.00 | $568.00 | $878.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.53 / $302.77 / $409.32
| Professional | | $184.53 | $302.77 | $409.32 |
- 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
- $155.52 / $308.39 / $641.51
| Professional | | $155.52 | $308.39 | $641.51 |