- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.82 / $283.82 / $1,632.38
| Professional | | $283.82 | $283.82 | $1,632.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.23 / $252.43 / $255.96
| Professional | | $232.23 | $252.43 | $255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.22 / $297.22 / $699.00
| Facility | | $297.22 | $297.22 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.95 / $388.63 / $529.84
| Professional | | $269.95 | $388.63 | $529.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.87 / $381.06 / $596.29
| Professional | | $295.87 | $381.06 | $596.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.82 / $283.82 / $1,632.38
| Professional | | $283.82 | $283.82 | $1,632.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.29 / $307.82 / $476.35
| Professional | | $212.29 | $307.82 | $476.35 |