- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.20 / $283.86 / $345.92
| Professional | | $196.20 | $283.86 | $345.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.08 / $282.73 / $425.98
| Professional | | $64.08 | $282.73 | $425.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.05 / $318.85 / $1,093.44
| Professional | | $212.05 | $318.85 | $1,093.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $265.66 / $349.14
| Professional | | $218.78 | $265.66 | $349.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.83 / $207.17 / $312.00
| Professional | | $35.83 | $207.17 | $312.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.32 / $288.70 / $363.66
| Professional | | $232.32 | $288.70 | $363.66 |