- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.07 / $318.58 / $377.54
| Professional | | $281.07 | $318.58 | $377.54 |
- 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 / $619.00 / $936.00
| Professional | | $570.00 | $619.00 | $936.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.22 / $588.37 / $910.57
| Professional | | $373.22 | $588.37 | $910.57 |
- 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
- $331.74 / $619.29 / $960.70
| Professional | | $331.74 | $619.29 | $960.70 |