- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.79 / $317.83 / $420.00
| Professional | | $223.79 | $317.83 | $420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.76 / $382.81 / $559.23
| Professional | | $256.76 | $382.81 | $559.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.60 / $377.60 / $699.00
| Facility | | $377.60 | $377.60 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.70 / $427.65 / $763.14
| Professional | | $271.70 | $427.65 | $763.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.06 / $438.99 / $779.16
| Professional | | $279.06 | $438.99 | $779.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.79 / $317.83 / $534.29
| Professional | | $223.79 | $317.83 | $534.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.23 / $437.42 / $713.49
| Professional | | $305.23 | $437.42 | $713.49 |