- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.55 / $233.81 / $256.14
| Facility | | $181.55 | $233.81 | $256.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.55 / $234.04 / $275.07
| Professional | | $181.55 | $234.04 | $275.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.10 / $287.10 / $287.10
| Professional | | $287.10 | $287.10 | $287.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.27 / $219.97 / $600.00
| Professional | | $193.27 | $219.97 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $70.00
| Professional | | $50.00 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.00 / $377.00 / $377.00
| Professional | | $377.00 | $377.00 | $377.00 |