- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.40 / $157.96 / $196.87
| Professional | | $149.40 | $157.96 | $196.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.00 / $252.00 / $252.00
| Facility | | $252.00 | $252.00 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.00 / $298.00 / $451.00
| Professional | | $294.00 | $298.00 | $451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.82 / $294.70 / $438.14
| Professional | | $191.82 | $294.70 | $438.14 |
- 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
- $200.27 / $294.16 / $452.55
| Professional | | $200.27 | $294.16 | $452.55 |