- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.16 / $150.16 / $214.87
| Professional | | $150.16 | $150.16 | $214.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.00 / $388.00 / $581.00
| Professional | | $277.00 | $388.00 | $581.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.12 / $249.85 / $351.76
| Professional | | $173.12 | $249.85 | $351.76 |
- 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
- $211.20 / $499.19 / $550.02
| Professional | | $211.20 | $499.19 | $550.02 |