- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.65 / $182.53 / $336.81
| Professional | | $146.65 | $182.53 | $336.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.00 / $287.00 / $287.00
| Facility | | $287.00 | $287.00 | $287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.00 / $420.00 / $776.00
| Professional | | $278.00 | $420.00 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.25 / $336.56 / $608.82
| Professional | | $182.25 | $336.56 | $608.82 |
- 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
- $261.37 / $459.54 / $772.22
| Professional | | $261.37 | $459.54 | $772.22 |