- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.10 / $144.10 / $248.61
| Professional | | $144.10 | $144.10 | $248.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.00 / $345.00 / $586.00
| Professional | | $276.00 | $345.00 | $586.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.34 / $303.32 / $524.42
| Professional | | $197.34 | $303.32 | $524.42 |
- 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
- $399.76 / $580.99 / $898.94
| Professional | | $399.76 | $580.99 | $898.94 |