- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.10 / $293.82 / $378.88
| Professional | | $265.10 | $293.82 | $378.88 |
- 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
- $518.00 / $572.00 / $866.00
| Professional | | $518.00 | $572.00 | $866.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.06 / $530.20 / $842.03
| Professional | | $335.06 | $530.20 | $842.03 |
- 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
- $386.25 / $555.84 / $864.00
| Professional | | $386.25 | $555.84 | $864.00 |