- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.07 / $165.68 / $219.97
| Professional | | $105.07 | $165.68 | $219.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.00 / $435.00 / $759.00
| Professional | | $281.00 | $435.00 | $759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.88 / $223.68 / $392.48
| Professional | | $138.88 | $223.68 | $392.48 |
- 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
- $185.69 / $315.00 / $669.24
| Professional | | $185.69 | $315.00 | $669.24 |