- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.11 / $158.60 / $219.28
| Professional | | $128.11 | $158.60 | $219.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.00 / $399.00 / $583.00
| Professional | | $279.00 | $399.00 | $583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.58 / $275.05 / $523.05
| Professional | | $162.58 | $275.05 | $523.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.20 / $547.79 / $909.48
| Professional | | $310.20 | $547.79 | $909.48 |