- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.23 / $225.23 / $255.34
| Professional | | $225.23 | $225.23 | $255.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.00 / $386.00 / $461.00
| Professional | | $343.00 | $386.00 | $461.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.80 / $373.14 / $506.91
| Professional | | $271.80 | $373.14 | $506.91 |
- 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
- $316.25 / $532.03 / $852.71
| Professional | | $316.25 | $532.03 | $852.71 |