- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.84 / $163.80 / $309.94
| Professional | | $139.84 | $163.80 | $309.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.68 / $436.24 / $545.37
| Professional | | $295.68 | $436.24 | $545.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.75 / $412.84 / $1,377.92
| Professional | | $177.75 | $412.84 | $1,377.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.47 / $347.32 / $468.52
| Professional | | $272.47 | $347.32 | $468.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.99 / $299.38 / $364.85
| Professional | | $182.99 | $299.38 | $364.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.03 / $319.64 / $503.22
| Professional | | $197.03 | $319.64 | $503.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.60 / $369.00 / $442.90
| Professional | | $301.60 | $369.00 | $442.90 |