- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.24 / $385.58 / $627.15
| Professional | | $320.24 | $385.58 | $627.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.12 / $155.09 / $238.10
| Facility | | $112.12 | $155.09 | $238.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.00 / $138.00 / $138.00
| Professional | | $138.00 | $138.00 | $138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $155.69 / $182.30
| Professional | | $27.40 | $155.69 | $182.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $274.07 / $1,300.00
| Facility | | $55.00 | $274.07 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.00 / $1,048.00 / $1,048.00
| Professional | | $1,048.00 | $1,048.00 | $1,048.00 |