- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.42 / $382.42 / $478.03
| Professional | | $382.42 | $382.42 | $478.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $150.00 / $150.00
| Professional | | $150.00 | $150.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.30 / $219.70 / $1,890.44
| Facility | | $215.30 | $219.70 | $1,890.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.14 / $1,432.00 / $5,807.00
| Professional | | $223.14 | $1,432.00 | $5,807.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.18 / $214.53 / $228.00
| Facility | | $130.18 | $214.53 | $228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.91 / $223.14 / $1,710.00
| Professional | | $115.91 | $223.14 | $1,710.00 |