- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.84 / $291.89 / $463.74
| Professional | | $134.84 | $291.89 | $463.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.00 / $547.00 / $1,000.00
| Professional | | $283.00 | $547.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.40 / $381.64 / $760.78
| Professional | | $215.40 | $381.64 | $760.78 |
- 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
- $374.70 / $665.19 / $1,033.98
| Professional | | $374.70 | $665.19 | $1,033.98 |