- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.97 / $257.72 / $410.79
| Professional | | $156.97 | $257.72 | $410.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.68 / $482.39 / $747.94
| Professional | | $338.68 | $482.39 | $747.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.54 / $329.95 / $468.38
| Professional | | $156.54 | $329.95 | $468.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.30 / $502.00 / $1,675.99
| Professional | | $269.30 | $502.00 | $1,675.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.07 / $482.39 / $694.75
| Professional | | $339.07 | $482.39 | $694.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.06 / $391.71 / $729.56
| Professional | | $257.06 | $391.71 | $729.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.00 / $373.00 / $585.10
| Professional | | $317.00 | $373.00 | $585.10 |