- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.84 / $276.00 / $422.95
| Professional | | $185.84 | $276.00 | $422.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.00 / $357.00 / $476.00
| Professional | | $241.00 | $357.00 | $476.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.37 / $334.62 / $483.74
| Professional | | $230.37 | $334.62 | $483.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.62 / $461.40 / $758.99
| Professional | | $280.62 | $461.40 | $758.99 |