- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.70 / $349.62 / $536.61
| Professional | | $279.70 | $349.62 | $536.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $575.12 / $575.12
| Professional | | $150.00 | $575.12 | $575.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.32 / $394.00 / $517.66
| Facility | | $244.32 | $394.00 | $517.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.67 / $1,286.00 / $1,306.17
| Professional | | $252.67 | $1,286.00 | $1,306.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.00 / $394.00 / $394.00
| Facility | | $394.00 | $394.00 | $394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.67 / $377.00 / $404.14
| Professional | | $252.67 | $377.00 | $404.14 |