- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.91 / $313.45 / $529.86
| Professional | | $233.91 | $313.45 | $529.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.39 / $397.71 / $580.00
| Professional | | $209.39 | $397.71 | $580.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.58 / $534.25 / $647.58
| Professional | | $341.58 | $534.25 | $647.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $518.61
| Professional | | $32.34 | $32.34 | $518.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.10 / $439.56 / $621.96
| Professional | | $325.10 | $439.56 | $621.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.61 / $539.82 / $730.73
| Professional | | $417.61 | $539.82 | $730.73 |