- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.00 / $130.38 / $156.21
| Professional | | $123.00 | $130.38 | $156.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.54 / $383.70 / $383.70
| Facility | | $120.54 | $383.70 | $383.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.00 / $154.00 / $466.06
| Professional | | $154.00 | $154.00 | $466.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.00 / $154.00 / $154.00
| Facility | | $154.00 | $154.00 | $154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.50 / $141.00 / $207.01
| Professional | | $128.50 | $141.00 | $207.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.00 / $205.70 / $236.50
| Professional | | $152.00 | $205.70 | $236.50 |