- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.69 / $284.50 / $384.49
| Professional | | $261.69 | $284.50 | $384.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.00 / $870.00 / $1,345.00
| Professional | | $725.00 | $870.00 | $1,345.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.98 / $469.41 / $677.81
| Professional | | $291.98 | $469.41 | $677.81 |
- 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
- $325.52 / $526.05 / $1,197.24
| Professional | | $325.52 | $526.05 | $1,197.24 |