- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.43 / $251.13 / $313.18
| Professional | | $242.43 | $251.13 | $313.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.00 / $252.00 / $252.00
| Facility | | $252.00 | $252.00 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.00 / $478.00 / $723.00
| Professional | | $474.00 | $478.00 | $723.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.12 / $460.15 / $701.88
| Professional | | $302.12 | $460.15 | $701.88 |
- 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
- $242.82 / $460.08 / $722.16
| Professional | | $242.82 | $460.08 | $722.16 |