- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.38 / $327.68 / $411.60
| Professional | | $307.38 | $327.68 | $411.60 |
- 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
- $578.00 / $616.00 / $932.00
| Professional | | $578.00 | $616.00 | $932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.76 / $597.59 / $907.92
| Professional | | $396.76 | $597.59 | $907.92 |
- 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
- $375.44 / $605.98 / $1,284.38
| Professional | | $375.44 | $605.98 | $1,284.38 |