- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $120.23 / $302.00
| Professional | | $72.44 | $120.23 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $354.81
| Professional | | $158.49 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $151.36 / $223.87
| Professional | | $112.20 | $151.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $3,090.30
| Facility | | $173.78 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $371.54
| Professional | | $125.89 | $213.80 | $371.54 |