- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.93 / $248.47 / $501.95
| Professional | | $154.93 | $248.47 | $501.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.88 / $271.20 / $648.89
| Professional | | $213.88 | $271.20 | $648.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.99 / $232.99 / $402.01
| Professional | | $232.99 | $232.99 | $402.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.13 / $351.58 / $815.07
| Professional | | $148.13 | $351.58 | $815.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.27 / $303.11 / $453.62
| Professional | | $259.27 | $303.11 | $453.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.22 / $267.72 / $415.49
| Professional | | $194.22 | $267.72 | $415.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.85 / $375.00 / $818.92
| Professional | | $169.85 | $375.00 | $818.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.87 / $331.29 / $803.37
| Professional | | $201.87 | $331.29 | $803.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.53 / $278.42 / $461.16
| Professional | | $174.53 | $278.42 | $461.16 |