- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $231.80 / $702.62
| Professional | | $151.16 | $231.80 | $702.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.00 / $422.00 / $643.00
| Professional | | $281.00 | $422.00 | $643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.49 / $261.60 / $457.04
| Professional | | $174.49 | $261.60 | $457.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.55 / $426.97 / $737.88
| Professional | | $242.55 | $426.97 | $737.88 |