- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.82 / $327.48 / $669.11
| Professional | | $138.82 | $327.48 | $669.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.81 / $253.94 / $457.28
| Professional | | $185.81 | $253.94 | $457.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.69 / $293.45 / $524.02
| Professional | | $216.69 | $293.45 | $524.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $78.00 / $468.10
| Professional | | $30.00 | $78.00 | $468.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.22 / $272.56 / $549.86
| Professional | | $253.22 | $272.56 | $549.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.10 / $360.45 / $571.11
| Professional | | $215.10 | $360.45 | $571.11 |