- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.19 / $250.54 / $311.43
| Professional | | $242.19 | $250.54 | $311.43 |
- 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
- $471.00 / $487.00 / $736.00
| Professional | | $471.00 | $487.00 | $736.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.82 / $481.68 / $714.42
| Professional | | $311.82 | $481.68 | $714.42 |
- 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
- $327.81 / $470.81 / $738.41
| Professional | | $327.81 | $470.81 | $738.41 |