- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.85 / $296.06 / $666.13
| Professional | | $236.85 | $296.06 | $666.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.42 / $505.93 / $690.59
| Facility | | $226.42 | $505.93 | $690.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.00 / $1,021.00 / $3,046.00
| Professional | | $446.00 | $1,021.00 | $3,046.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.00 / $406.00 / $406.00
| Facility | | $406.00 | $406.00 | $406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.70 / $366.00 / $446.00
| Professional | | $214.70 | $366.00 | $446.00 |