- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $125.89 / $186.21
| Professional | | $97.72 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $181.97 / $354.81
| Professional | | $100.00 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $154.88 / $199.53
| Professional | | $102.33 | $154.88 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $13,803.84 / $19,498.45
| Facility | | $5,888.44 | $13,803.84 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $147.91
| Professional | | $117.49 | $117.49 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $102.33 / $213.80
| Professional | | $64.57 | $102.33 | $213.80 |