- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.47 / $191.85 / $388.58
| Professional | | $153.47 | $191.85 | $388.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $360.07 / $360.07
| Professional | | $150.00 | $360.07 | $360.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.25 / $202.59 / $308.41
| Facility | | $96.25 | $202.59 | $308.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.03 / $347.00 / $1,367.00
| Professional | | $141.03 | $347.00 | $1,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.00 / $258.00 / $258.00
| Facility | | $258.00 | $258.00 | $258.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.03 / $248.00 / $347.00
| Professional | | $141.03 | $248.00 | $347.00 |