- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $42.42 / $503.28
| Professional | | $30.00 | $42.42 | $503.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.24 / $324.24 / $719.20
| Professional | | $324.24 | $324.24 | $719.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.00 / $455.00 / $784.00
| Professional | | $280.00 | $455.00 | $784.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $480.00 / $548.16
| Professional | | $42.42 | $480.00 | $548.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $76.48
| Professional | | $50.00 | $60.00 | $76.48 |