- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.10 / $171.78 / $284.38
| Professional | | $140.10 | $171.78 | $284.38 |
- 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
- $266.00 / $402.00 / $670.00
| Professional | | $266.00 | $402.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.16 / $310.02 / $581.62
| Professional | | $190.16 | $310.02 | $581.62 |
- 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
- $273.73 / $397.16 / $679.92
| Professional | | $273.73 | $397.16 | $679.92 |