- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.65 / $209.92 / $275.89
| Professional | | $128.65 | $209.92 | $275.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.00 / $528.00 / $930.00
| Professional | | $341.00 | $528.00 | $930.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.71 / $272.79 / $495.12
| Professional | | $165.71 | $272.79 | $495.12 |
- 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
- $220.15 / $398.65 / $850.07
| Professional | | $220.15 | $398.65 | $850.07 |