- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.23 / $339.15 / $434.14
| Professional | | $310.23 | $339.15 | $434.14 |
- 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
- $601.00 / $652.00 / $986.00
| Professional | | $601.00 | $652.00 | $986.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.61 / $620.46 / $958.46
| Professional | | $396.61 | $620.46 | $958.46 |
- 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
- $349.60 / $644.29 / $1,027.01
| Professional | | $349.60 | $644.29 | $1,027.01 |