- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.29 / $171.51 / $214.30
| Professional | | $165.29 | $171.51 | $214.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.00 / $413.00 / $665.00
| Professional | | $344.00 | $413.00 | $665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.53 / $339.60 / $424.12
| Professional | | $214.53 | $339.60 | $424.12 |
- 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
- $201.48 / $351.74 / $596.71
| Professional | | $201.48 | $351.74 | $596.71 |