- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.34 / $229.61 / $631.14
| Professional | | $191.34 | $229.61 | $631.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.58 / $446.58 / $446.58
| Professional | | $446.58 | $446.58 | $446.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.54 / $543.54 / $570.72
| Facility | | $543.54 | $543.54 | $570.72 |