- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.57 / $412.43 / $429.48
| Professional | | $385.57 | $412.43 | $429.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $40.83
| Professional | | $30.00 | $30.00 | $40.83 |
- 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
- $73.18 / $73.18 / $73.18
| Professional | | $73.18 | $73.18 | $73.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.47 / $128.47 / $128.47
| Professional | | $128.47 | $128.47 | $128.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.57 / $412.43 / $429.48
| Professional | | $385.57 | $412.43 | $429.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.47 / $128.47 / $128.47
| Professional | | $128.47 | $128.47 | $128.47 |