- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.69 / $146.68 / $209.21
| Professional | | $105.69 | $146.68 | $209.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.00 / $383.00 / $592.00
| Professional | | $289.00 | $383.00 | $592.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.35 / $205.72 / $351.30
| Professional | | $128.35 | $205.72 | $351.30 |
- 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
- $158.27 / $261.64 / $594.00
| Professional | | $158.27 | $261.64 | $594.00 |