- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.94 / $206.36 / $341.47
| Professional | | $160.94 | $206.36 | $341.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.00 / $752.00 / $752.00
| Facility | | $752.00 | $752.00 | $752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.00 / $473.00 / $741.00
| Professional | | $313.00 | $473.00 | $741.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.58 / $360.40 / $689.41
| Professional | | $223.58 | $360.40 | $689.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.48 / $494.54 / $768.72
| Professional | | $264.48 | $494.54 | $768.72 |