- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.80 / $407.01 / $515.41
| Professional | | $319.80 | $407.01 | $515.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.00 / $136.00 / $136.00
| Professional | | $136.00 | $136.00 | $136.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.60 / $145.60 / $264.20
| Professional | | $145.60 | $145.60 | $264.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.00 / $362.58 / $362.58
| Facility | | $124.00 | $362.58 | $362.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.00 / $653.00 / $653.00
| Professional | | $653.00 | $653.00 | $653.00 |