- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $309.03
| Professional | | $173.78 | $245.47 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $316.23
| Facility | | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $309.03
| Professional | | $218.78 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $549.54
| Professional | | $338.84 | $426.58 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $269.15 / $323.59
| Facility | | $251.19 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $323.59 / $912.01
| Professional | | $151.36 | $323.59 | $912.01 |