- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.76 / $310.27 / $392.51
| Professional | | $236.76 | $310.27 | $392.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $150.00
| Professional | | $100.00 | $100.00 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.11 / $284.24 / $338.98
| Facility | | $221.11 | $284.24 | $338.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.48 / $702.03 / $826.04
| Professional | | $198.48 | $702.03 | $826.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.48 / $313.58 / $371.91
| Professional | | $198.48 | $313.58 | $371.91 |