- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.71 / $176.71 / $239.35
| Professional | | $176.71 | $176.71 | $239.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.00 / $434.00 / $650.00
| Professional | | $326.00 | $434.00 | $650.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.20 / $293.89 / $406.53
| Professional | | $211.20 | $293.89 | $406.53 |
- 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
- $264.55 / $460.12 / $702.24
| Professional | | $264.55 | $460.12 | $702.24 |