- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.58 / $286.83 / $701.63
| Professional | | $239.58 | $286.83 | $701.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.37 / $215.37 / $215.37
| Professional | | $215.37 | $215.37 | $215.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.00 / $510.00 / $510.00
| Professional | | $510.00 | $510.00 | $510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.43 / $366.09 / $505.61
| Professional | | $211.43 | $366.09 | $505.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $192.03
| Professional | | $32.34 | $32.34 | $192.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.43 / $292.77 / $606.96
| Professional | | $216.43 | $292.77 | $606.96 |