- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.85 / $249.72 / $334.95
| Professional | | $143.85 | $249.72 | $334.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.00 / $671.00 / $1,273.00
| Professional | | $434.00 | $671.00 | $1,273.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.38 / $333.80 / $636.47
| Professional | | $193.38 | $333.80 | $636.47 |
- 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
- $297.45 / $519.55 / $1,040.17
| Professional | | $297.45 | $519.55 | $1,040.17 |