- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.12 / $253.70 / $302.10
| Professional | | $225.12 | $253.70 | $302.10 |
- 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
- $457.00 / $492.00 / $744.00
| Professional | | $457.00 | $492.00 | $744.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.26 / $470.03 / $724.99
| Professional | | $306.26 | $470.03 | $724.99 |
- 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
- $270.56 / $493.85 / $798.20
| Professional | | $270.56 | $493.85 | $798.20 |