- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.54 / $356.49 / $429.22
| Professional | | $297.54 | $356.49 | $429.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $85.00 / $99.00
| Professional | | $14.00 | $85.00 | $99.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.30 / $52.30 / $157.10
| Professional | | $52.30 | $52.30 | $157.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.11 / $230.50 / $237.78
| Facility | | $142.11 | $230.50 | $237.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.32 / $541.32 / $541.32
| Professional | | $541.32 | $541.32 | $541.32 |