- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.94 / $98.87 / $742.33
| Professional | | $85.94 | $98.87 | $742.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.00 / $162.00 / $1,236.00
| Professional | | $132.00 | $162.00 | $1,236.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.38 / $211.52 / $1,102.73
| Professional | | $122.38 | $211.52 | $1,102.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.76 / $796.89 / $1,643.39
| Professional | | $298.76 | $796.89 | $1,643.39 |