- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.53 / $224.77 / $312.91
| Professional | | $128.53 | $224.77 | $312.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.97 / $311.61 / $580.35
| Professional | | $190.97 | $311.61 | $580.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.46 / $277.61 / $521.58
| Professional | | $151.46 | $277.61 | $521.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.08 / $269.08 / $598.41
| Professional | | $269.08 | $269.08 | $598.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $222.20 / $675.20
| Professional | | $5.00 | $222.20 | $675.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.69 / $288.64 / $670.01
| Professional | | $203.69 | $288.64 | $670.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.00 / $1,772.32 / $2,080.58
| Professional | | $1,118.00 | $1,772.32 | $2,080.58 |