- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.91 / $327.50 / $410.71
| Professional | | $292.91 | $327.50 | $410.71 |
- 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
- $570.00 / $617.00 / $934.00
| Professional | | $570.00 | $617.00 | $934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.23 / $585.82 / $909.04
| Professional | | $370.23 | $585.82 | $909.04 |
- 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
- $328.32 / $549.90 / $956.78
| Professional | | $328.32 | $549.90 | $956.78 |