- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.54 / $455.00 / $473.38
| Professional | | $350.54 | $455.00 | $473.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.34 / $42.34 / $42.34
| Professional | | $42.34 | $42.34 | $42.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.53 / $105.53 / $105.53
| Facility | | $105.53 | $105.53 | $105.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $2.48 / $3.10
| Professional | | $2.48 | $2.48 | $3.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.91 / $350.91 / $350.91
| Professional | | $350.91 | $350.91 | $350.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.54 / $455.00 / $500.50
| Professional | | $350.54 | $455.00 | $500.50 |