- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.46 / $224.80 / $356.56
| Professional | | $180.46 | $224.80 | $356.56 |
- 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
- $342.00 / $517.00 / $818.00
| Professional | | $342.00 | $517.00 | $818.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.76 / $389.84 / $748.22
| Professional | | $245.76 | $389.84 | $748.22 |
- 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
- $376.32 / $534.94 / $848.90
| Professional | | $376.32 | $534.94 | $848.90 |