- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.04 / $230.17 / $524.54
| Professional | | $129.04 | $230.17 | $524.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.29 / $349.28 / $493.07
| Professional | | $217.29 | $349.28 | $493.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.08 / $305.08 / $699.00
| Facility | | $305.08 | $305.08 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.53 / $358.58 / $663.48
| Professional | | $189.53 | $358.58 | $663.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.42 / $387.06 / $686.99
| Professional | | $230.42 | $387.06 | $686.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.04 / $234.53 / $524.54
| Professional | | $129.04 | $234.53 | $524.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.62 / $322.56 / $651.11
| Professional | | $239.62 | $322.56 | $651.11 |